Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures

Renan C. Castillo, Michael J. Bosse, Ellen J. MacKenzie, Brendan M. Patterson, Andrew R. Burgess, Alan L. Jones, James F. Kellam, Mark P. McAndrew, Melissa L. McCarthy, Charles A. Rohde, Roy Sanders, Marc F. Swiontkowski, Lawrence X. Webb, Julie Agel, Jennifer Avery, Denise Bailey, Wendall Bryan, Debbie Bullard, Carla Carpenter, Elizabeth ChaparroKate Corbin, Denise Darnell, Stephaine Dickason, Thomas DiPasquale, Betty Harkin, Michael Harrington, Dolfi Herscovici, Amy Holdren, Linda Howard, Sarah Hutchings, Marie Johnson, Melissa Jurewicz, Donna Lampke, Karen Lee, Marianne Mars, Maxine Mendoza-Welch, J. Wayne Meredith, Nan Morris, Karen Murdock, Andrew Pollak, Pat Radey, Sandy Shelton, Sherry Simpson, Steven Sims, Douglas Smith, Adam Starr, Celia Weigman, John Wilber, Stephanie Williams, Philip Wolinsky, Mary Woodman, Michelle Zimmerman

Research output: Contribution to journalArticle

221 Citations (Scopus)

Abstract

Objectives: 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. Setting: Eight Level I trauma centers. Patients: 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). Outcome measure: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)151-157
Number of pages7
JournalJournal of Orthopaedic Trauma
Volume19
Issue number3
DOIs
StatePublished - Mar 2005

Fingerprint

Open Fractures
Fracture Healing
Tibia
Osteomyelitis
Extremities
Smoking
Infection
Trauma Centers
Smoking Cessation
Survival Analysis
History
Outcome Assessment (Health Care)
Wounds and Injuries

Keywords

  • Infection
  • Osteomyelitis
  • Smoking
  • Tibia fracture
  • Union

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Castillo, R. C., Bosse, M. J., MacKenzie, E. J., Patterson, B. M., Burgess, A. R., Jones, A. L., ... Zimmerman, M. (2005). Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. Journal of Orthopaedic Trauma, 19(3), 151-157. https://doi.org/10.1097/00005131-200503000-00001

Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. / Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.; Patterson, Brendan M.; Burgess, Andrew R.; Jones, Alan L.; Kellam, James F.; McAndrew, Mark P.; McCarthy, Melissa L.; Rohde, Charles A.; Sanders, Roy; Swiontkowski, Marc F.; Webb, Lawrence X.; Agel, Julie; Avery, Jennifer; Bailey, Denise; Bryan, Wendall; Bullard, Debbie; Carpenter, Carla; Chaparro, Elizabeth; Corbin, Kate; Darnell, Denise; Dickason, Stephaine; DiPasquale, Thomas; Harkin, Betty; Harrington, Michael; Herscovici, Dolfi; Holdren, Amy; Howard, Linda; Hutchings, Sarah; Johnson, Marie; Jurewicz, Melissa; Lampke, Donna; Lee, Karen; Mars, Marianne; Mendoza-Welch, Maxine; Meredith, J. Wayne; Morris, Nan; Murdock, Karen; Pollak, Andrew; Radey, Pat; Shelton, Sandy; Simpson, Sherry; Sims, Steven; Smith, Douglas; Starr, Adam; Weigman, Celia; Wilber, John; Williams, Stephanie; Wolinsky, Philip; Woodman, Mary; Zimmerman, Michelle.

In: Journal of Orthopaedic Trauma, Vol. 19, No. 3, 03.2005, p. 151-157.

Research output: Contribution to journalArticle

Castillo, RC, Bosse, MJ, MacKenzie, EJ, Patterson, BM, Burgess, AR, Jones, AL, Kellam, JF, McAndrew, MP, McCarthy, ML, Rohde, CA, Sanders, R, Swiontkowski, MF, Webb, LX, Agel, J, Avery, J, Bailey, D, Bryan, W, Bullard, D, Carpenter, C, Chaparro, E, Corbin, K, Darnell, D, Dickason, S, DiPasquale, T, Harkin, B, Harrington, M, Herscovici, D, Holdren, A, Howard, L, Hutchings, S, Johnson, M, Jurewicz, M, Lampke, D, Lee, K, Mars, M, Mendoza-Welch, M, Meredith, JW, Morris, N, Murdock, K, Pollak, A, Radey, P, Shelton, S, Simpson, S, Sims, S, Smith, D, Starr, A, Weigman, C, Wilber, J, Williams, S, Wolinsky, P, Woodman, M & Zimmerman, M 2005, 'Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures', Journal of Orthopaedic Trauma, vol. 19, no. 3, pp. 151-157. https://doi.org/10.1097/00005131-200503000-00001
Castillo, Renan C. ; Bosse, Michael J. ; MacKenzie, Ellen J. ; Patterson, Brendan M. ; Burgess, Andrew R. ; Jones, Alan L. ; Kellam, James F. ; McAndrew, Mark P. ; McCarthy, Melissa L. ; Rohde, Charles A. ; Sanders, Roy ; Swiontkowski, Marc F. ; Webb, Lawrence X. ; Agel, Julie ; Avery, Jennifer ; Bailey, Denise ; Bryan, Wendall ; Bullard, Debbie ; Carpenter, Carla ; Chaparro, Elizabeth ; Corbin, Kate ; Darnell, Denise ; Dickason, Stephaine ; DiPasquale, Thomas ; Harkin, Betty ; Harrington, Michael ; Herscovici, Dolfi ; Holdren, Amy ; Howard, Linda ; Hutchings, Sarah ; Johnson, Marie ; Jurewicz, Melissa ; Lampke, Donna ; Lee, Karen ; Mars, Marianne ; Mendoza-Welch, Maxine ; Meredith, J. Wayne ; Morris, Nan ; Murdock, Karen ; Pollak, Andrew ; Radey, Pat ; Shelton, Sandy ; Simpson, Sherry ; Sims, Steven ; Smith, Douglas ; Starr, Adam ; Weigman, Celia ; Wilber, John ; Williams, Stephanie ; Wolinsky, Philip ; Woodman, Mary ; Zimmerman, Michelle. / Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. In: Journal of Orthopaedic Trauma. 2005 ; Vol. 19, No. 3. pp. 151-157.
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abstract = "Objectives: 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. Setting: Eight Level I trauma centers. Patients: 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). Outcome measure: 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. Conclusion: 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.",
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author = "Castillo, {Renan C.} and Bosse, {Michael J.} and MacKenzie, {Ellen J.} and Patterson, {Brendan M.} and Burgess, {Andrew R.} and Jones, {Alan L.} and Kellam, {James F.} and McAndrew, {Mark P.} and McCarthy, {Melissa L.} and Rohde, {Charles A.} and Roy Sanders and Swiontkowski, {Marc F.} and Webb, {Lawrence X.} and Julie Agel and Jennifer Avery and Denise Bailey and Wendall Bryan and Debbie Bullard and Carla Carpenter and Elizabeth Chaparro and Kate Corbin and Denise Darnell and Stephaine Dickason and Thomas DiPasquale and Betty Harkin and Michael Harrington and Dolfi Herscovici and Amy Holdren and Linda Howard and Sarah Hutchings and Marie Johnson and Melissa Jurewicz and Donna Lampke and Karen Lee and Marianne Mars and Maxine Mendoza-Welch and Meredith, {J. Wayne} and Nan Morris and Karen Murdock and Andrew Pollak and Pat Radey and Sandy Shelton and Sherry Simpson and Steven Sims and Douglas Smith and Adam Starr and Celia Weigman and John Wilber and Stephanie Williams and Philip Wolinsky and Mary Woodman and Michelle Zimmerman",
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T1 - Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures

AU - Castillo, Renan C.

AU - Bosse, Michael J.

AU - MacKenzie, Ellen J.

AU - Patterson, Brendan M.

AU - Burgess, Andrew R.

AU - Jones, Alan L.

AU - Kellam, James F.

AU - McAndrew, Mark P.

AU - McCarthy, Melissa L.

AU - Rohde, Charles A.

AU - Sanders, Roy

AU - Swiontkowski, Marc F.

AU - Webb, Lawrence X.

AU - Agel, Julie

AU - Avery, Jennifer

AU - Bailey, Denise

AU - Bryan, Wendall

AU - Bullard, Debbie

AU - Carpenter, Carla

AU - Chaparro, Elizabeth

AU - Corbin, Kate

AU - Darnell, Denise

AU - Dickason, Stephaine

AU - DiPasquale, Thomas

AU - Harkin, Betty

AU - Harrington, Michael

AU - Herscovici, Dolfi

AU - Holdren, Amy

AU - Howard, Linda

AU - Hutchings, Sarah

AU - Johnson, Marie

AU - Jurewicz, Melissa

AU - Lampke, Donna

AU - Lee, Karen

AU - Mars, Marianne

AU - Mendoza-Welch, Maxine

AU - Meredith, J. Wayne

AU - Morris, Nan

AU - Murdock, Karen

AU - Pollak, Andrew

AU - Radey, Pat

AU - Shelton, Sandy

AU - Simpson, Sherry

AU - Sims, Steven

AU - Smith, Douglas

AU - Starr, Adam

AU - Weigman, Celia

AU - Wilber, John

AU - Williams, Stephanie

AU - Wolinsky, Philip

AU - Woodman, Mary

AU - Zimmerman, Michelle

PY - 2005/3

Y1 - 2005/3

N2 - Objectives: 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. Setting: Eight Level I trauma centers. Patients: 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). Outcome measure: 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. Conclusion: 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.

AB - Objectives: 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. Setting: Eight Level I trauma centers. Patients: 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). Outcome measure: 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. Conclusion: 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.

KW - Infection

KW - Osteomyelitis

KW - Smoking

KW - Tibia fracture

KW - Union

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