title: Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Eight Level I trauma centers.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017102:Fracture Healing; D005597:Fractures, Open / Q000145:classification / Q000150:complications / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects*; D013978:Tibial Fractures / Q000145:classification / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D014193:Trauma Centers