Smoking as a predictor of negative outcome in diaphyseal fracture healing.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures. METHODS: We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis. RESULTS: In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p < 0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p < 0.05), while external fixation was associated with better bone healing (p < 0.05). CONCLUSION: Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.