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Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures.

Authors
Castillo-RC; Bosse-MJ; MacKenzie-EJ; Patterson-BM; LEAP Study Group
Source
J Orthop Trauma 2005 Mar; 19(3):151-157
NIOSHTIC No.
20037740
Abstract
OBJECTIVES: Current data show smoking is associated with a number of complications of the fracture healing process. A concern, however, is the potential confounding effect of covariates associated with smoking. The present study is the first to prospectively examine time to union, as well as major complications of the fracture healing process, while adjusting for potential confounders. SETTING: Eight Level I trauma centers. PATIENTS: Patients with unilateral open tibia fractures were divided into 3 baseline smoking categories: never smoked (n = 81), previous smoker (n = 82), and current smoker (n = 105). OUTCOME MEASURE: Time to fracture healing, diagnosis of infection, and osteomyelitis. METHODS: Survival and logistic analyses were used to study differences in time to fracture healing and the likelihood of developing complications, respectively. Multivariate models were used to adjust for injury severity, treatment variations, and patient characteristics. RESULTS: After adjusting for covariates, current and previous smokers were 37% (P = 0.01) and 32% (P = 0.04) less likely to achieve union than nonsmokers, respectively. Current smokers were more than twice as likely to develop an infection (P = 0.05) and 3.7 times as likely to develop osteomyelitis (P = 0.01). Previous smokers were 2.8 times as likely to develop osteomyelitis (P = 0.07), but were at no greater risk for other types of infection. CONCLUSION: Smoking places the patient at risk for increased time to union and complications. Previous smoking history also appears to increase the risk of osteomyelitis and increased time to union. The results highlight the need for orthopaedic surgeons to encourage their patients to enter a smoking cessation programs.
Keywords
Smoking; Tobacco; Tobacco-smoke; Injuries; Traumatic-injuries; Humans; Men; Women; Age-groups; Author Keywords: smoking; tibia fracture; union; infection; osteomyelitis
Contact
Renan C. Castillo, MSc, Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 544, Baltimore, MD 21205
CODEN
JORTE5
Publication Date
20050301
Document Type
Journal Article
Funding Type
Grant
Fiscal Year
2005
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-T42-OH-008428
Issue of Publication
3
ISSN
0890-5339
Source Name
Journal of Orthopaedic Trauma
State
MD
Performing Organization
Johns Hopkins University
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