Orthopedic doctors need to emphasize the dangers of e-cigarettes and vaping when it comes to bone fracture healing, according to a new study. Researchers found that a majority of patients don’t believe e-cigarettes and vaping has any impact on the healing process.
85% of Vapers Doubt It Hurts Bone Healing. Huh?
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The new study, “The New Era of Nicotine: Better for Patients?” was released as a part of the American Academy of Orthopaedic Surgeons’ (AAOS) Virtual Education. According to the findings, both smokers and non-smokers believe that these smoking alternatives do not have the same harmful effects as traditional cigarettes, despite there being evidence that they also cause wound complications, infections and nonunions.
“Many smokers, especially adolescents and young adults, don’t realize that e-cigarettes contain similar chemicals to those found in traditional cigarettes, such as anti-freeze, formaldehyde, nicotine and tobacco—all with varying degrees of concentration,” said Colin T. Ackerman, M.D., lead author and orthopedic resident at Temple University Hospital in Philadelphia.
“Unfortunately, e-cigarettes have been positioned as a safer alternative and a solution to help people quit smoking. Much of this narrative has caused misconceptions when it comes to how e-cigarettes can impact a person’s bone health, not to mention their overall health and wellness.”
For the study, the researchers developed a multiple-choice survey and distributed to 231 patients, 18 years and older, who were being treated for an extremity fracture. About half of the patients were male; 46% were African American. The mean age was 46 years old. The study was conducted at an outpatient orthopedic surgery clinic at a Level 1 urban trauma center.
Overall, 41% of the patients reported using cigarettes or e-cigarettes. And 79.8% of these smokers did it daily. The researchers found that more nonsmokers (22.8%) than smokers (14.7%) felt that e-cigarettes “definitely” impaired fracture healing, but the percentages were still on the low side.
They found that many people also still don’t believe that regular cigarettes “definitely” impair fracture healing. Only 29.4% of nonsmokers and 20% of smokers believed that it could.
The good news was that 87.6% of the smokers said they would be interested in stopping smoking if they were told nicotine could impair their healing.
“It’s our hope that this information can be used to guide clinicians in acquiring more thorough social health histories and better inform patients about the dangers of not only traditional cigarette smoking, but smoking alternatives,” co-author Christopher Haydel, M.D. said.
He added that more research is needed to understand the health impact of all of the smoking alternatives coming to market.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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