title: The effect of smoking on bone healing: A systematic review.
abstract: OBJECTIVE
  To review the systemic impact of smoking on bone healing as evidenced within the orthopaedic literature.
  
  
  METHODS
  A protocol was established and studies were sourced from five electronic databases. Screening, data abstraction and quality assessment was conducted by two review authors. Prospective and retrospective clinical studies were included. The primary outcome measures were based on clinical and/or radiological indicators of bone healing. This review specifically focused on non-spinal orthopaedic studies.
  
  
  RESULTS
  Nine tibia studies and eight other orthopaedic studies were considered for systematic review. Of these 17 studies, 13 concluded that smoking negatively influenced bone healing.
  
  
  CONCLUSIONS
  Smoking has a negative effect on bone healing, in terms of delayed union, nonunion and more complications.
authors.affiliation: King's College London Dental Institute, Departmentof Periodontology, Guy's Hospital Campus, LondonSE1 9RT, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Patel
authors.forename: R F
authors.initials: RF
authors.lastname: Wilson
authors.forename: P A
authors.initials: PA
authors.lastname: Patel
authors.forename: R M
authors.initials: RM
authors.lastname: Palmer
keywords: Bone healing; Bone repair; Fracture healing; Smoking; Systematic review