Cigarette smoking and open tibial fractures

Adams, C. I.; Keating, J. F.; Court-Brown, C. M.

doi:10.1016/s0020-1383(00)00121-2

Cited by 205 publications

(129 citation statements)

References 17 publications

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“…The deleterious effects of smoking on bone healing were already known in tibial fractures [6,11,12,18]. Adams compared complications rates in 140 smoking and 133 non-smoking patients with open tibial fractures [4]. Both groups were evenly matched demographically and in terms of primary fracture treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The influence of nicotine on bone healing in animals remains controversial; nicotine exposure enhances angiogenesis but cannot compensate for the adverse effect of vasoconstriction [3]. Clinically, the consequences of smoking on bone healing are less clear [4][5][6][7][8][9][10]. Several non-randomized and uncontrolled studies have suggested a deleterious effect of tobacco, resulting in delayed healing and increased rates of nonunion [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the rate of nonunion in closed tibial fractures is low with modern methods of treatment. Open diaphyseal tibial fractures have been demonstrated to be associated with higher rates of nonunion and of re-operation to achieve union, and smoking has been demonstrated in these complex lesions to impair bone healing [4,6,11,12]. Tobacco is not the only predictive factor in tibial fractures; other suggested barriers to fracture healing include chronic illness, malnutrition, prior radiation, bone loss, fracture comminution with bone and soft tissue devascularization, instability and infection [14].…”

Section: Introductionmentioning

confidence: 99%

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Smoking as a predictor of negative outcome in diaphyseal fracture healing

Hernigou

Schuind

2013

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Smoking as a predictor of negative outcome in diaphyseal fracture healing

Hernigou

Schuind

2013

International Orthopaedics (SICOT)

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“…To ensure comparability of both groups, comorbidities were measured by the Charlson Index [26]. If patients smoked more than 10 cigarettes per day at the time of injury, they were classified as smokers [1] and any systemic steroid therapy at the time of injury was accounted for. AP and transscapular radiographic examinations at the time of injury, after surgery, and at the time of last followup (mean, 30 months; range, 12-83 months) were available for all patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Neer Group VI Proximal Humeral Fractures: Retrospective Comparison of PHILOS® and Hemiarthroplasty

Spross

Platz

Erschbamer

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…1 Previous studies have shown a relationship between smoking and a variety of orthopedic conditions, including delayed healing and nonunion of fractures in human and animal models. [2][3][4][5] An inadequate or delayed fracture healing response results in a significant cost to society in terms of lost work productivity and recreational ability. Currently, the molecular mechanism by which smoking causes deleterious effects on fracture healing is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Smoking delays chondrogenesis in a mouse model of closed tibial fracture healing

et al. 2006

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Smoking delays the healing process and increases morbidity associated with many common musculoskeletal disorders, including long bone fracture. In the current study, a murine model of tibial fracture healing was used to test the hypothesis that smoking delays chondrogenesis after fracture. Mice were divided into two groups, a nonsmoking control group and a group exposed to cigarette smoke for 1 month prior to surgical tibial fracture. Mice were euthanized at 7, 14, and 28 days after surgery. The outcomes measured were immunohistochemical staining for type II collagen protein expression as a marker of cartilage matrix and proliferating cell nuclear antigen (PCNA) staining to measure proliferation at the site of injury. Toluidine blue staining and histomorphometry were used to quantify areas of cartilaginous and noncartilaginous fracture callus. Radiographs were analyzed for evidence of remodeling after injury. At day 7 after injury, mice exposed to cigarette smoke had a smaller fracture callus with less cartilage matrix compared to controls. Proliferation was present at high levels in both groups at this time point, but proliferating cells had a more immature morphology in the smoking group. At day 14, chondrogenesis was more active in smokers compared to controls, while a higher percentage of bone was present in the control animals. At day 28, X-ray analysis revealed a larger fracture callus remaining in the smoking animals. Together, these findings show that the chondrogenic phase of tibial fracture healing is delayed by smoking. This study represents, to our knowledge, the first analysis of molecular and cellular mechanisms of healing in a smoking mouse fracture model. ß

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Cigarette smoking and open tibial fractures

Cited by 205 publications

References 17 publications

Smoking as a predictor of negative outcome in diaphyseal fracture healing

Smoking as a predictor of negative outcome in diaphyseal fracture healing

Surgical Treatment of Neer Group VI Proximal Humeral Fractures: Retrospective Comparison of PHILOS® and Hemiarthroplasty

Smoking delays chondrogenesis in a mouse model of closed tibial fracture healing

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