Failure of surgery for scaphoid non-union is associated with smoking.
Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3-10.1, p=0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.
Nuffield Orthopaedic Centre, Headington, Oxford, UK.
C P
CP
Little
B J
BJ
Burston
J
J
Hopkinson-Woolley
P
P
Burge
D000328:Adult; D001863:Bone Screws; D015331:Cohort Studies; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation; D011884:Radius / Q000637:transplantation; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects* / Q000503:physiopathology*; D017211:Treatment Failure