OBJECTIVES: Current data show smoking is associated with a number of complications of the fracture healing process. A concern, however, is the potential confounding effect of covariates associated with smoking. The present study is the first to prospectively examine time to union, as well as major complications of the fracture healing process, while adjusting for potential confounders. SETTING: Eight Level I trauma centers. PATIENTS: Patients with unilateral open tibia fractures were divided into 3 baseline smoking categories: never smoked (n = 81), previous smoker (n = 82), and current smoker (n = 105). OUTCOME MEASURE: Time to fracture healing, diagnosis of infection, and osteomyelitis. METHODS: Survival and logistic analyses were used to study differences in time to fracture healing and the likelihood of developing complications, respectively. Multivariate models were used to adjust for injury severity, treatment variations, and patient characteristics. RESULTS: After adjusting for covariates, current and previous smokers were 37% (P = 0.01) and 32% (P = 0.04) less likely to achieve union than nonsmokers, respectively. Current smokers were more than twice as likely to develop an infection (P = 0.05) and 3.7 times as likely to develop osteomyelitis (P = 0.01). Previous smokers were 2.8 times as likely to develop osteomyelitis (P = 0.07), but were at no greater risk for other types of infection. CONCLUSION: Smoking places the patient at risk for increased time to union and complications. Previous smoking history also appears to increase the risk of osteomyelitis and increased time to union. The results highlight the need for orthopaedic surgeons to encourage their patients to enter a smoking cessation programs.
OBJECTIVES: Current data show smoking is associated with a number of complications of the fracture healing process. A concern, however, is the potential confounding effect of covariates associated with smoking. The present study is the first to prospectively examine time to union, as well as major complications of the fracture healing process, while adjusting for potential confounders. SETTING: Eight Level I trauma centers. PATIENTS: Patients with unilateral open tibia fractures were divided into 3 baseline smoking categories: never smoked (n = 81), previous smoker (n = 82), and current smoker (n = 105). OUTCOME MEASURE: Time to fracture healing, diagnosis of infection, and osteomyelitis. METHODS: Survival and logistic analyses were used to study differences in time to fracture healing and the likelihood of developing complications, respectively. Multivariate models were used to adjust for injury severity, treatment variations, and patient characteristics. RESULTS: After adjusting for covariates, current and previous smokers were 37% (P = 0.01) and 32% (P = 0.04) less likely to achieve union than nonsmokers, respectively. Current smokers were more than twice as likely to develop an infection (P = 0.05) and 3.7 times as likely to develop osteomyelitis (P = 0.01). Previous smokers were 2.8 times as likely to develop osteomyelitis (P = 0.07), but were at no greater risk for other types of infection. CONCLUSION: Smoking places the patient at risk for increased time to union and complications. Previous smoking history also appears to increase the risk of osteomyelitis and increased time to union. The results highlight the need for orthopaedic surgeons to encourage their patients to enter a smoking cessation programs.
Authors: João Paulo B Ximenez; Ariane Zamarioli; Melissa A Kacena; Rommel Melgaço Barbosa; Fernando Barbosa Journal: Biol Trace Elem Res Date: 2020-04-30 Impact factor: 3.738
Authors: Renan C Castillo; Yanjie Huang; Daniel Scharfstein; Katherine Frey; Michael J Bosse; Andrew N Pollak; Heather A Vallier; Kristin R Archer; Robert A Hymes; Anna B Newcomb; Ellen J MacKenzie; Stephen Wegener; Joseph R Hsu; Madhav A Karunakar; Rachel B Seymour; Stephen H Sims; Eileen Flores; Christine Churchill; David J Hak; Corey E Henderson; Hassan R Mir; Daniel S Chan; Anjan R Shah; Barbara Steverson; Jerald Westberg; Joshua L Gary; Timothy S Achor; Andrew Choo; John W Munz; Melissa Porrey; Sarah Hendrickson; Mary A Breslin; Todd O McKinley; Greg E Gaski; Laurence B Kempton; Anthony T Sorkin; Walter W Virkus; Lauren C Hill; Clifford B Jones; Debra L Sietsema; Robert V O'Toole; Katherine Ordonio; Andrea L Howe; Timothy J Zerhusen; William Obremskey; Robert H Boyce; A Alex Jahangir; Cesar S Molina; Manish K Sethi; Susan W Vanston; Eben A Carroll; Danielle Yemiola Drye; Martha B Holden; Susan C Collins; Elizabeth Wysocki Journal: JAMA Surg Date: 2019-02-20 Impact factor: 14.766
Authors: François Durand; Philippe Berthelot; Celine Cazorla; Frederic Farizon; Frederic Lucht Journal: Int Orthop Date: 2013-02-27 Impact factor: 3.075