Effect of Smoking on the Union Time of Femur and Tibia Shaft Fractures Treated with Intramedullary Nailing

Öz

Aim: Numerous negative effects of smoking on human health are known. One of them is its deleterious effect on the bone healing process. Emerging evidence suggests that fracture union is delayed and complications are more frequent in smokers. The majority of studies on this subject include a wide age range of patients and multiple treatment modalities. The aim of this study is to examine the effect of smoking on delayed union or nonunion in a more homogeneous patient group. Method: Seventy-three patients aged between 18 and 40 who underwent intramedullary nailing surgery for femur or tibia shaft fractures between 2015 and 2020, were categorized into smokers and non-smokers groups. All electronic records, x-rays and archive files of these patients were reviewed retrospectively. Results: There were 37 patients in smokers group and 36 in non-smokers group. The mean union time for fractures was 26.1 weeks in smokers and 16.3 weeks in non-smokers. The mean time to union was significantly longer in the smokers group (p=0.001). No significant difference was found in terms of nonunion and infection rates. Conclusion: Smoking is associated with low bone density and an increased risk of fracture, delayed union, and nonunion. Patients who have any bone fracture or who will have an elective bone surgery should be warned to quit smoking as soon as possible.

Anahtar Kelimeler

• smoking
• hookah
• electronic cigarette
• bone healing
• fracture union

İntrameduller Çivileme ile Tedavi Edilmiş Femur ve Tibia Şaft Kırıklarında, Sigara Kullanımının Kaynama Süresine Olan Etkisi

Öz

Amaç: Sigaranın insan sağlığına olan birçok olumsuz etkisi bilinmektedir. Bunlardan biri de kemik iyileşme sürecine olan negatif etkisidir. Sigara içen bireylerde kırık kaynama süresinin daha uzun olduğu ve daha çok komplikasyon geliştiği yönünde kanıtlar artmaktadır. Bu konudaki çalışmaların çoğunluğu geniş bir yaş aralığı ve birden fazla tedavi şekli içermektedir. Amacımız sigaranın kaynama gecikmesine veya kaynamamaya etkisini daha homojen bir hasta grubunda incelemektir. Yöntem: 18-40 yaş arası femur şaft veya tibia şaft kırığı geçirmiş ve sadece intramedüller çivileme yöntemiyle 2015 ile 2020 yılları arasında ameliyat edilmiş 73 hasta; sigara içen grup ve sigara içmeyen grup olarak ikiye ayrıldı. Bu hastaların tüm bilgisayar kayıtları, x-ray grafileri ve arşiv dosyaları geriye dönük olarak incelendi. Bulgular: Sigara içen grupta 37, içmeyen grupta 36 hasta mevcuttu. Sigara içen hastaların kırık kaynama süresi ortalama 26,1 hafta; içmeyen hastaların ise ortalama 16,3 hafta olarak bulundu. İstatistiksel olarak sigara içen grubun ortalama kırık kaynama süresi anlamlı uzundu (p=0,001). Kaynamama ve enfeksiyon oranları açısından ise anlamlı fark bulunamadı. Sonuç: Sigara; düşük kemik yoğunluğuna, artmış kırık ve kaynamama riskine, geç kaynamaya ve ameliyatla ilgili komplikasyonlarda artışa neden olmaktadır. Kemik kırığı gelişen veya elektif kemik ameliyatı olacak kişiler sigara kullanıyorsa, en kısa sürede bırakması için uyarılmalıdır.

Anahtar Kelimeler

• nargile
• sigara
• elektronik sigara
• kemik iyileşmesi
• kırık kaynaması

Kaynakça

1. 1- Hernigou J, Schuind F. Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone Joint Res. 2019;8(6):255-265.
2. 2- Patel RA, Wilson RF, Patel PA, Palmer RM. The effect of smoking on bone healing: A systematic review. Bone Joint Res. 2013;2(6):102-111.
3. 3- 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(3):151-157.
4. 4- Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M. The effects of smoking on fracture healing. Surgeon. 2010 Apr;8(2):111-6.
5. 5- Hernigou J, Schuind F. Smoking as a predictor of negative outcome in diaphyseal fracture healing. Int Orthop. 2013 May;37(5):883-7.
6. 6- Tarantino U, Cariati I, Greggi C, Gasbarra E, Belluati A, Ciolli L, Maccauro G, Momoli A, Ripanti S, Falez F, Brandi ML. Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic. Int J Mol Sci. 2021 Jun 21;22(12):6629.
7. 7- 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 Mar;19(3):151-7.
8. 8- Pearson R.G., Clement R., Edwards K., Scammell B.E. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open. 2016;6: e010303.

9. 9- Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res. 1999 Aug;(365):184-200.
10. 10- Kyrö A, Usenius JP, Aarnio M, Kunnamo I, Avikainen V. Are smokers a risk group for delayed healing of tibial shaft fractures? Ann Chir Gynaecol. 1993;82(4):254-62.
11. 11- Sasaki M, Chubachi S, Kameyama N, Sato M, Haraguchi M, Miyazaki M, Takahashi S, Nakano T, Kuroda Y, Betsuyaku T, Matsuo K. Effects of long-term cigarette smoke exposure on bone metabolism, structure, and quality in a mouse model of emphysema. PLoS One. 2018 Jan 30;13(1): e0191611.
12. 12- Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J. Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014 Apr 16;96(8):674-81.
13. 13- Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004 Jun 26;328(7455):1519.
14. 14- Lindström D, Sadr Azodi O, Wladis A, Tønnesen H, Linder S, Nåsell H, Ponzer S, Adami J. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008 Nov;248(5):739-45.
15. 15- Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011 Feb;124(2):144-154.e8.
16. 16- El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control. 2015 Mar;24 Suppl 1(Suppl 1): i31-i43.
17. 17- Münzel T, Hahad O, Kuntic M, Keaney JF, Deanfield JE, Daiber A. Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. Eur Heart J. 2020 Nov 1;41(41):4057-4070.
18. 18- Carnevale R, Sciarretta S, Violi F, Nocella C, Loffredo L, Perri L, Peruzzi M, Marullo AG, De Falco E, Chimenti I, Valenti V, Biondi-Zoccai G, Frati G. Acute Impact of Tobacco vs Electronic Cigarette Smoking on Oxidative Stress and Vascular Function. Chest. 2016 Sep;150(3):606-12.