Cigarette smoking influences the clinical and occupational outcome of patients with tibial shaft fractures

Tibial shaft fracture is one of the most common types of bone fracture in young patients. In this prospective clinical cohort study, we investigated the effects of cigarette smoking on the clinical, functional, psychosocial and occupational outcomes after isolated lower-leg fracture. We examined 85 patients, including 61 men and 24 women, with a collective mean age of 46 years (range: 18-84 years). Thirty-nine patients had never smoked (G1) and 45 patients were current or previous smokers (G2). The G2 group displayed a significantly increased risk for delayed union or nonunion (G1 = 3 patients, G2 = 18 patients; P = 0.0007) and increased time required for fracture healing (mean times: G1 = 11.9 weeks, G2 = 17.4 weeks; p = 0.003) and a markedly increased time out of work (mean times: G1 = 16.1 weeks, G2 = 21.5 weeks; p = 0.1177 (not significant)). The 18 negatively affected patients in G2 displayed a significant increase in the time required for fracture healing and time out of work (26 weeks (p = 0.02) and 31 weeks (p = 0.03), respectively). G2 group members had a 3- to 18-fold higher risk of impaired bone healing. The mean Short Form 36 (SF-36) was similar in both groups. The physical-function scores were G1 = 49.6 and G2 = 48.6; the mental scores were G1 = 52.7 and G2 = 52.8. These findings indicate that smoking significantly increases the risk of impaired fracture healing, which has clinical and occupational consequences for the affected patients. Based on our data, we developed a score to estimate the individual risk of impaired fracture healing. These types of patients must be informed and closely monitored to determine the need for timely re-intervention with additional therapy, such as BMP s or ultrasound. (C) 2011 Elsevier Ltd. All rights reserved.