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17-11-2011 | Surgery | Article

Smoking slows tibial shaft fracture patient recovery

Abstract

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MedWire News: Patients with tibial shaft fracture should be warned that smoking impairs bone healing, slowing recovery and extending their period away from work, German clinicians say.

"These patients are typically healthy, active, and at the peak of their professional and private achievements," comment Arash Moghaddam (Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig) and co-authors.

"For this reason, the interruption of their normal lifestyles, following injury and during the subsequent healing period, is accompanied by adverse social and economic consequence."

The team examined the impact of cigarette smoking on the healing of 61 men and 24 women, aged an average of 46 years, with isolated lower leg fractures and no severe soft tissue injury.

Patients were divided into never smokers (n=39) and current or past smokers (n=45).

As reported in the journal Injury, smokers were significantly more likely to experience delayed union (nine vs three cases) or nonunion (none vs nine cases) than their nonsmoking counterparts.

Smokers also experienced a significantly longer time to fracture healing than nonsmokers (17.4 vs 11.9 weeks), and a longer period of time away from work (21.5 vs 16.1 weeks).

Overall, 18 smokers experienced delayed fracture healing, defined as pain on weight-bearing and lack of visible bony consolidation on X-ray after 4 months. These patients took an average of 26 weeks to heal and spent 31 weeks out of work.

Although the mean Short Form-36 physical function score did not significantly differ between smokers and nonsmokers, nonsmokers had significantly better Lysholm scores for knee function, and Merchant and Dietz scores for ankle function than smokers.

Moghaddam et al suggest that patients be assessed for risk for adverse bone healing and informed about the adverse impact of cigarette smoking on their recovery. They add that patients should be closely monitored for fracture healing and assessed for further surgery or other treatment strategies where necessary.

By Lynda Williams

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