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. 2013 May;37(5):883-7.
doi: 10.1007/s00264-013-1809-5. Epub 2013 Feb 8.

Smoking as a predictor of negative outcome in diaphyseal fracture healing

Jacques Hernigou  1 , Frédéric Schuind
Affiliations

Smoking as a predictor of negative outcome in diaphyseal fracture healing

Jacques Hernigou et al. Int Orthop. 2013 May.

Abstract

Purpose: The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures.

Methods: We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis.

Results: In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p < 0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p < 0.05), while external fixation was associated with better bone healing (p < 0.05).

Conclusion: Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.

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Figures

Fig. 1
Fig. 1
Diagram analysis of the 114 fractures. Among the patients that presented open fractures associated with tobacco, 69 % had a nonunion versus 21 % for patients presenting closed fractures without tobacco used. This was a statistically significant difference with p < 0.001 and OR = 8.25, 95% CI (2.4–28.34). O+ open fracture, O− closed fracture, T+ smoking, T− no smoking, U union, NU nonunion
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Comment in

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