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Smoking linked to longer healing time for fractures

Monday March 25, 2013
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For patients who sustain fractures or traumatic bone injuries, smoking leads to longer healing times and an increased rate of postoperative complication and infection, according to a data analysis.

"Cigarette smoking is widely recognized as one of the major causes of preventable disease in the United States, but there has been a lack of evidence showing other side effects of smoking, such as how it changes the way our bones heal," Samir Mehta, MD, chief of the Orthopaedic Trauma and Fracture Service at the Perelman School of Medicine at the University of Pennsylvania, said in a news release.

"Our study adds substantial support to a growing body of evidence showing that smoking presents a significant risk to fracture patients. These risks need to be addressed with the patient both at the time of injury and when considering surgical treatment."

For all injury types, according to the analysis, fractured bones in patients who smoke take roughly six weeks longer to heal than fractured bones in a nonsmoker (30.2 weeks vs. 24.1 weeks). Additional results show that fractured bones in patients who smoke are 2.3 times more likely to result in non-unions than are fractured bones in nonsmokers.

Using Medline, EMBASE and Cochrane computerized literature databases, the researchers collated previous studies that have examined the effects of smoking on bone and soft tissue healing. By analyzing these studies, the team sought to find an association between smoking and healing time, and various complications such as postsurgical infection.

Studies included in the analysis, which was presented March 22 in Chicago at the American Academy of Orthopaedic Surgeonsí annual meeting, focused on fractures of the tibia, femur or hip, ankle, humerus, and multiple long bones. In total, 6,480 patient cases (treated both surgically and nonsurgically) were evaluated in the studies.

With approximately 6.8 million fractures requiring medical treatment in the U.S. annually, the researchers said the overall burden of musculoskeletal disease is substantial. "The effects of smoking intervention programs need to be discussed and instituted to promote better outcomes for post-fracture patients," Mehta said. "We have an opportunity to help patients understand that itís about more than just heart health, and that smoking puts you at a higher risk of complications and leads to longer healing times."

The researchers said future studies are needed to evaluate the dose-dependent effects of smoking on fracture healing. In addition, the increasing use and production of smokeless tobacco presents new questions about the effects of nicotine, and other tobacco products, through non-combustible forms. Finally, studies that better delineate the impact of directed education and the effects of the timing of smoking cessation (both before and after surgery) on the post-operative complication rate also are needed to provide the best care for fracture patients.

The study abstract is available at http://bit.ly/13rl3jo.

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