Smoking Increases Postoperative Complications After Distal Radius Fracture Fixation: A Review of 417 Patients From a Level 1 Trauma Center

Abstract

Background: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to affect bone healing and implant fixation rates but has never been definitively shown to affect postoperative outcomes of surgically managed distal radius fractures. Methods: A retrospective review was performed of patients with surgically treated distal radius fractures at a Level 1 Trauma Center who had at least 6 weeks of follow-up over a 5-year period. Charts were reviewed for basic demographic information, comorbidities, details about the operative procedure, and early complications. Notable physical examination findings were noted, such as wrist stiffness and distal radius tenderness to palpation. Statistical analysis was performed to compare the smoking and nonsmoking groups. To control for confounding differences, a hierarchical multivariable regression analysis was performed. Results: Four hundred seventeen patients were included in the study, and 24.6% were current smokers at the time of surgery. The overall complication rate for smokers was 9.8% compared with 5.6% in nonsmokers. The smoking cohort showed significantly higher rates of hardware removal, nonunion, revision procedures, wrist stiffness, and distal radius tenderness. When controlling for the confounding variables of diabetes and obesity, smokers still had significantly higher rates of the same complications. Conclusion: Patients who smoke have a statistically significant higher rate of postoperative distal radius tenderness, wrist stiffness, nonunion, hardware removal, and revision procedures compared with those who do not smoke in a review of 417 total patients undergoing surgical fixation for distal radius fractures.

Smoking Dependent Alterations in Bone Formation and Inflammation Represent Major Risk Factors for Complications Following Total Joint Arthroplasty

“…Despite frequent reports on smoking as a risk factor for osteoporosis, fragility fractures, and associated post-surgical complication (e.g., delayed/impaired healing, infections, or revision surgeries) [3,4,5,6,7,8,9], little is known about the underlying mechanisms. Consequently, handling of smokers during and after musculoskeletal surgeries remains a huge challenge, as no specific treatment strategies exist for these patients.…”

“…An extended meta-analysis by Pearson et al showed not only significantly delayed fracture healing but also a higher frequency of non-unions after fracture, spinal fusion, osteotomy, or arthrodesis in smokers [7]. This finding is fostered by the retrospective study of Hess et al reporting a higher frequency of post-surgical tenderness, wrist stiffness, non-unions, and revision surgeries in smokers with distal radius fractures (when compared to non-smokers) [6].…”

“…Consequently, smokers seem to be at higher risk for fragility fractures [4,5]. For example, in patients with distal radius fractures, smokers show more frequently post-surgical tenderness, wrist stiffness, non-union, and revision surgeries as compared to non-smokers [6]. Similarly, Pearson et al reported not only a significant delay in fracture healing, but also a two-fold increase in the risk for developing a non-union after fracture, spinal fusion, osteotomy or arthrodesis in smokers [7].…”

The outcome for surgical fixation of distal radial fractures in patients with idiopathic Parkinson’s disease: a cohort study

“…Although the majority of patients that receive surgical fixation for DRF have good to excellent outcomes, PD patients appear to have inferior results. In the general population, the nonunion rate is reported to be as low as < 1% and the overall complication rate in current literature for DRF ranges from 14 to 30% in the general population [4,[12][13][14]. In our study, we considered patients to have a treatment failure if there was loss of reduction, malunion or nonunion of fracture, or persistent pain at the injured site 6 months after surgery.…”

The outcome for surgical fixation of distal radial fractures in patients with Idiopathic Parkinson’s Disease: a cohort study

“…In the general population, the nonunion rate is reported to be as low as < 1% and the overall complication rate in current literature for DRF ranges from 14% to 30% in the general population. 4,[12][13][14] In our study, we considered patients to have a treatment failure if there was loss of reduction, malunion or nonunion of fracture, or persistent pain at the injured site 6 months after surgery. We noted 4.6% of the non-PD patients had treatment failure, while 39.1% of the patients in the PD group were considered to have treatment failure.…”