title: Smoking as a predictor of negative outcome in diaphyseal fracture healing.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures.
  
  
  METHODS
  We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis.
  
  
  RESULTS
  In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p < 0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p < 0.05), while external fixation was associated with better bone healing (p < 0.05).
  
  
  CONCLUSIONS
  Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.
authors: Department of Orthopaedics and Traumatology, Erasme University Hospital, 808, route de Lennik, 1070, Brussels, Belgium. jacques.hernigou@ulb.ac.be
authors: Jacques
authors: J
authors: Hernigou
authors: Frédéric
authors: F
authors: Schuind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000628:therapy; D017102:Fracture Healing / Q000187:drug effects*; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy*; D005599:Fractures, Ununited / Q000209:etiology / Q000473:pathology*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013978:Tibial Fractures / Q000150:complications / Q000628:therapy; D055815:Young Adult
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