The effect of smoking on bone healing: A systematic review

R A Patel, R F Wilson, P A Patel, R M Palmer, R A Patel, R F Wilson, P A Patel, R M Palmer

Abstract

Objectives: To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature.

Methods: A protocol was established and studies were sourced from five electronic databases. Screening, data abstraction and quality assessment was conducted by two review authors. Prospective and retrospective clinical studies were included. The primary outcome measures were based on clinical and/or radiological indicators of bone healing. This review specifically focused on non-spinal orthopaedic studies.

Results: Nine tibia studies and eight other orthopaedic studies were considered for systematic review. Of these 17 studies, 13 concluded that smoking negatively influenced bone healing.

Conclusions: Smoking has a negative effect on bone healing, in terms of delayed union, nonunion and more complications.

Keywords: Bone healing; Bone repair; Fracture healing; Smoking; Systematic review.

Conflict of interest statement

ICMJE Conflict of Interest:None declared

Figures

Fig. 1
Fig. 1
Flow diagram for the systematic review.

References

    1. Al-Hadithy N, Sewell MD, Bhavikatti M, Gikas PD. The effect of smoking on fracture healing and on various orthopaedic procedures. Acta Orthop Belg 2012;78:285–290
    1. Gaston MS, Simpson AH. Inhibition of fracture healing. J Bone Joint Surg [Br] 2007;89-B:1553–1560
    1. Kwiatkowski TC, Hanley EN Jr, Ramp WK. Cigarette smoking and its orthopedic consequences. Am J Orthop (Belle Mead NJ) 1996;25:590–597
    1. Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M. The effects of smoking on fracture healing. Surgeon 2010;8:111–116
    1. Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: the diamond concept. Injury 2007;38(Suppl 4):S3–S6
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006–1012
    1. Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM. ; LEAP Study Group. Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 2005;19:151–157
    1. Adams CI, Keating JF, Court-Brown CM. Cigarette smoking and open tibial fractures. Injury 2001;32:61–65
    1. Harvey EJ, Agel J, Selznick HS, Chapman JR, Henley MB. Deleterious effect of smoking on healing of open tibia-shaft fractures. Am J Orthop 2002;31:518–521
    1. Ristiniemi J, Flinkkilä T, Hyvönen P, et al. Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases. J Trauma 2007;62:174–183
    1. Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res 1999;365:184–200
    1. Alemdaroglu KB, Tiftikci U, Iltar S, et al. Factors affecting the fracture healing in treatment of tibial shaft fractures with circular external fixator. Injury 2009;40:1151–1156
    1. Meidinger G, Imhoff AB, Paul J, et al. May smokers and overweight patients be treated with a medial open-wedge HTO?: risk factors for non-union. Knee Surg Sports Traumatol Arthrosc 2011;19:333–339
    1. W-Dahl A, Toksvig-Larsen S. Cigarette smoking delays bone healing: a prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand 2004;75:347–351
    1. W-Dahl A, Toksvig-Larsen S. No delayed bone healing in Swedish male oral snuffers operated on by the hemicallotasis technique: a cohort study of 175 patients. Acta Orthop 2007;78:791–794
    1. Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of the femoral diaphysis: the influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg [Br] 2000;82-B:655–658
    1. Kenawey M, Krettek C, Liodakis E, Meller R, Hankemeier S. Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system. Clin Orthop Relat Res 2011;469:264–273
    1. Krannitz KW, Fallat LM, Schwartz SM. Radiographic healing of conservative versus operative management of supination-external rotation II fractures in a smoking and premature weight-bearing population. J Foot Ankle Surg 2007;46:218–222
    1. Chen F, Osterman AL, Mahony K. Smoking and bony union after ulna-shortening osteotomy. Am J Orthop 2001;30:486–489
    1. Chahal J, Stephen DJ, Bulmer B, Daniels T, Kreder HJ. Factors associated with outcome after subtalar arthrodesis. J Orthop Trauma 2006;20:555–561
    1. Collman DR, Kaas MH, Schuberth JM. Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients. Foot Ankle Int 2006;27:1079–1085
    1. Perlman MH, Thordarson DB. Ankle fusion in a high risk population: an assessment of nonunion risk factors. Foot Ankle Int 1999;20:491–496
    1. Krannitz KW, Fong HW, Fallat LM, Kish J. The effect of cigarette smoking on radiographic bone healing after elective foot surgery. J Foot Ankle Surg 2009;48:525–527
    1. Rajan RA, Ong M, Jones S, Fernandes J. Does smoking affect the quality of bone regenerate in paediatric limb reconstructive surgery? J Child Orthop 2007;1:365–367
    1. Lores Obradors L, Monsó Molas E, Rosell Gratacós A, Badorrey I, Sampablo Lauro I. Do patients lie about smoking during follow-up in the respiratory medicine clinic. Arch Bronconeumol 1999;35:219–222 (in Spanish).
    1. Scott DA, Palmer RM, Stapleton JA. Validation of smoking status in clinical research into inflammatory periodontal disease. J Clin Periodontol 2001;28:715–722
    1. Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health 1987;77:1435–1438
    1. Hoogendoorn JM, van der Werken C. The adverse effects of smoking on healing of open tibial fractures. Ned Tijdschr Geneeskd 2002;146:1640–1644 (in Dutch).
    1. Moghaddam A, Zimmermann G, Hammer K, et al. Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures. Injury 2011;42:1435–1442

Source: PubMed

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