The effect of cigarette smoking on radiographic bone healing after elective foot surgery.

UNLABELLED: This study aims to compare radiographic healing rates of Austin bunionectomies in smokers, nonsmokers, and secondhand smokers. Delayed bone healing has been linked to cigarette smoking previously, but no study is known to have examined smoking in relation to elective foot surgery. We hypothesized that smoking will delay bone healing after elective foot surgery. Surgical patients were placed into 1 of 3 cigarette smoking-related groups. Nicotine dependence was measured by the standardized modified Fagerström est and a urine cotinine test. Bone healing was determined via examination of postsurgical radiographs. Outcomes were assessed with 1-way analyses of variance. Forty-six patients were prospectively evaluated. There were 17 smokers, 12 secondhand smokers, and 17 nonsmokers. Healing time after Austin bunionectomy was 69 days (SD = 26.0), 120 days (SD = 55.3), and 78 days (SD = 19.1) in nonsmokers, smokers, and secondhand smokers, respectively. It was noted that as urine cotinine number increased, the healing time also increased (Pearson correlation = -.314, P < .01). The same was noted with the score associated with the Fagerström questionnaire, showing an increase in healing time with an increase in score (Pearson correlation = -.128, P < .05). The osteotomy of a smoker took 1.73 times longer to reach radiographic bone consolidation than that of a nonsmoker. This equates to a 42% increase in time to bone healing in the smoking patient. Increased healing time was also correlated to increased urine cotinine and a higher Fagerström number. Smoking is shown to delay radiographic healing. LEVEL OF CLINICAL EVIDENCE: 2.

Radiographic healing of conservative versus operative management of supination-external rotation II fractures in a smoking and premature weight-bearing population.

The treatment of supination-external rotation II fibular fractures continues to be an area of debate. In the event of minimal displacement at the fracture, both surgical management and casting have been supported. This study aims to compare the time interval of radiographic healing in both the surgically and conservatively managed patient. Additional factors such as premature weight bearing and smoking were also examined. Fifty-two charts were examined retrospectively. This included 26 patients in both the surgical and conservative populations. Radiographs were examined for the presence of healing. Anterior-posterior, mortise, and lateral-view x-rays were examined. The presence of cortical bridging and a resolution of fracture line primarily on lateral view at the posterior spike were used to evaluate healing. The mean time for cortical bridging to occur was 89.38 days in the conservative group and 48.69 days in the surgical group. Mean times for healing were significantly longer in both smokers and patients who prematurely bore weight when treated in both the surgical and conservative populations. In the treatment of isolated fibular fractures, surgical intervention appears to offer a faster time to radiographic healing. Smoking and premature weight bearing are shown to prolong the time to radiographic healing in both the surgically and conservatively treated patient populations.