Smoking associated with delayed shinbone healing

June 28, 2018

In adults, tibia (shinbone) fractures are usually fixed through the surgical implantation of a slender metal rod called an intramedullary nail in the hollow space within the bone. This treatment is generally effective for tibial fractures. However, in 10% to 15% of cases the bone fails to heal in a timely manner, resulting in a nonunion--or arrested healing.

This is considered a serious complication in the healing of a fracture with major consequences. Patients who experience nonunion can be significantly affected by pain, increased duration of opioid use, and depression. Medical costs and lost wages are also high, and only about 60% of nonunion patients are able to return to work within one year.

In an interdisciplinary study by Hannah Dailey, assistant professor in the Department of Mechanical Engineering and Mechanics and Ping-Shi Wu, associate professor in the Department of Mathematics, both at Lehigh University, a team of researchers examined 1,003 patient records from a large database compiled by the world's leading experts on nonunion, Dr. Charles Court-Brown and Dr. Margaret McQueen--both of the Royal Infirmary of Edinburgh, Scotland--of patients treated in their trauma center over a 20+ year period: 1985-2007.

The results will be published in the July issue of Journal of Orthopaedic Trauma in a paper called: "Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing: Risk Factors Based on a Single-Center Review of 1003 Patients," and co-authored by Katherine A. Wu, a statistics student and President's Scholar at Lehigh, as well as Dr. Court-Brown and Dr. McQueen, of the Department of Orthopaedic Trauma, Royal Infirmary of Edinburgh, University of Edinburgh.

One surprising result the researchers found was that patients in the middle decades of life, particularly women aged 30-49, seemed to be at increased risk of nonunion.

"This finding does not have a simple obvious biological explanation, and suggests that there are other factors--such as living environment, employment, activity levels and others--that could be contributing to bone healing in a way that isn't easy to measure," says Dailey.

Another important result from the study was that smoking significantly delays bone healing.

"We are all familiar with some of the more well-known negative health effects of smoking, but the influence on bone healing is less widely known outside the medical community," says Dailey. "Our study recommended that all fracture patients should be provided with support for smoking cessation to help reduce the risk of complications related to their injury."

From the study: "Smoking did not increase the risk of nonunion but did significantly extend the median time to union. Nonunion risk also shows a nonlinear trend with age and women in middle adulthood may be at increased risk compared with all other groups. This finding is not explained by the distributions of injury characteristics and suggests that exogenous factors, such as weight-bearing behavior, may have a contributing effect and should be objectively measured in future prospective investigations."

Adds Dailey: "This paper illustrates how Lehigh's culture of interdisciplinary research and undergraduate research involvement makes exciting things possible. I'm not a statistician, but I was connected to Professor Wu through a Lehigh undergraduate who was studying statistics and working for me one summer in the Biosystems Dynamics Summer Institute (BDSI) program on an unrelated project and that relationship grew into a long-term collaboration and produced this exciting study."
-end-


Lehigh University

Related Smoking Articles from Brightsurf:

Smoking rates falling in adults, but stroke survivors' smoking rates remain steady
While the rate of Americans who smoke tobacco has fallen steadily over the last two decades, the rate of stroke survivors who smoke has not changed significantly.

What is your risk from smoking? Your network knows!
A new study from researchers at Penn's Annenberg School for Communication found that most people, smokers and non-smokers alike, were nowhere near accurate in their answers to questions about smoking's health effects.

Want to quit smoking? Partner up
Kicking the habit works best in pairs. That's the main message of a study presented today at EuroPrevent 2019, a scientific congress of the European Society of Cardiology (ESC).

Smoking and mortality in Asia
In this analysis of data from 20 studies conducted in China, Japan, South Korea, Singapore, Taiwan and India with more than 1 million participants, deaths associated with smoking continued to increase among men in Asia grouped by the years in which they were born.

Predictors of successfully quitting smoking among smokers registered at the quit smoking clinic at a public hospital in northeastern Malaysia
In the current issue of Family Medicine and Community Health, Nur Izzati Mohammad et al. consider how cigarette smoking is one of the risk factors leading to noncommunicable diseases such as cardiovascular and respiratory system diseases and cancer.

Restaurant and bar smoking bans do reduce smoking, especially among the highly educated
Smoking risk drops significantly in college graduates when they live near areas that have completely banned smoking in bars and restaurants, according to a new study in the American Journal of Epidemiology.

How the UK smoking ban increased wellbeing
Married women with children reported the largest increase in well-being following the smoking bans in the UK in 2006 and 2007 but there was no comparable increase for married men with children.

Smoking study personalizes treatment
A simple blood test is allowing Vanderbilt University Medical Center (VUMC) researchers to determine which patients should be prescribed varenicline (Chantix) to stop smoking and which patients could do just as well, and avoid side effects, by using a nicotine patch.

A biophysical smoking gun
While much about Alzheimer's disease remains a mystery, scientists do know that part of the disease's progression involves a normal protein called tau, aggregating to form ropelike inclusions within brain cells that eventually strangle the neurons.

A case where smoking helped
A mutation in the hemoglobin of a young woman in Germany was found to cause her mild anemia.

Read More: Smoking News and Smoking Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.