Abstract
To evaluate the effects of smoking on fracture healing in a non-union population.
A consecutive cohort of 104 patients with 107 non-unions managed by external fixation was reviewed. 75% were regular smokers compared to the regional average of 3 0%. 5 8 male and 20 female smokers, matched with the non-smoking group. Patients’ records and x-rays were evaluated; where information was missing patients were contacted by phone/post. Scoring was recorded from our own prospective database.
The smokers underwent 2. 6 procedures per segment with a mean treatment time of 17. 43 months (4–64) compared to 1. 9 and 10. 9 (2. 5–24) respectively in non-smoking group. The total hospital stay was 66% greater in the smoking group (41. 12 vs 27. 4 days).
102 non-unions healed, including seven who required revision surgery, six of whom were smokers. In smoking group five went on to amputation and three had residual infection. The entire non-smoking group healed after primary surgery except a 70 years old lady who was converted to intramedullary nailing.
The final assessment of the bony and functional results was performed by the method described by Paley and Catagni (JBJS 77A 1995).
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When considered in the context of regional statistics for smoking there was a trend towards non-union in smokers [P< 0. 05].
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When limb reconstruction treatment was compared between the two groups despite the low number of infected cases in the smoking group, the number of surgical procedures, duration of treatment and hospital stay were all increased.
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Failure, revision rate and residual infection were high in the smoking groups.
We conclude that smoking adversely affects both primary fracture healing and non-union treatment.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom
