Smoking Slows Fracture Healing

Another reason to stop smoking, as if another were needed: Broken bones take longer to heal if the victims are smokers, reports Nancy Walsh, staff writer for MedPage Today, on March 24. In a systematic literature review and a random effects model meta-analysis that included 20 studies with 6, 500 patients and 1, 500 smokers, conducted by Mara Schencker, M.D. and her colleagues at the University of Pennsylvania, Philadelphia, they found that individuals who smoked had a 15% higher risk for the nonunion of fractures of the long bones and periarticular long bones than did nonsmokers.

“It’s been proposed that smoking may be detrimental to healing through mechanisms including vasoconstriction, platelet aggregation, direct inhibition of cell function, and decreased collagen synthesis, ” said Schencker. Together, she added, these effects have been implicated in higher rates of nonunion both in arthrodesis and fracture studies and in greater complications in all surgical subspecialties.

Healing times for all fractures averaged 24.1 weeks for nonsmokers and 30.2 weeks for smokers, and times for tibia fractures were 25.1 weeks versus 32 weeks. Walsh reported that for tibial nonunions, smokers had a 15% higher risk and for open-fracture nonunions, the risk was increased by 12%, Schencker reported. There also were non-significant trends for increased incidence of infections. For deep infections, the rate was 7% for smokers and 2% for nonsmokers while the rates of superficial infections were 7% and 4%, respectively.