Smoking associated with delayed shinbone healing

June 28, 2018, Lehigh University

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 of smoking, but the influence on bone healing is less widely known outside the medical community," says Dailey. "Our study recommended that all fracture 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."

Explore further: Study with implications for opioid crisis finds opioids raise risk of fracture nonunion

More information: Hannah L. Dailey et al, Tibial Fracture Nonunion and Time to Healing After Reamed Intramedullary Nailing, Journal of Orthopaedic Trauma (2018). DOI: 10.1097/BOT.0000000000001173

Related Stories

Study with implications for opioid crisis finds opioids raise risk of fracture nonunion

June 15, 2018
Dr. Robert Zura, Professor and Chair of Orthopaedic Surgery at LSU Health New Orleans School of Medicine, was part of a research team reporting that not only may opioid use increase the risk of bone fractures, but opioids ...

Why bones don't heal: Researchers identify risk factors for nonunion of fractures

September 7, 2016
Dr. Robert Zura, the Robert D'Ambrosia Professor and Head of Orthopaedic Surgery at LSU Health New Orleans School of Medicine, was part of a research team that identified risk factors which may help orthopaedic surgeons better ...

Smoking affects fracture healing

March 22, 2013
In a new study presented today at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), researchers reviewed existing literature on smoking and the healing of fractures involving long bones (bones ...

Denosumab does not delay nonvertebral fracture healing

December 19, 2012
(HealthDay)—Denosumab does not appear to delay fracture healing or contribute to other complications when used to treat postmenopausal women with osteoporosis, according to research published in the Dec. 5 issue of The ...

Prognostic factors identified for intramedullary tibial nailing

October 21, 2012
(HealthDay)—Fracture and surgical factors have been identified for the prediction of adverse outcomes after intramedullary nailing of tibial shaft fractures, according to a study published in the Oct. 3 issue of The Journal ...

Common gene variants linked to delayed healing of bone fractures

October 14, 2014
Slow-healing or non-healing bone fractures in otherwise healthy people may be caused by gene variants that are common in the population, according to Penn State College of Medicine researchers.

Recommended for you

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

Surgery, not antibiotics, should remain first-line treatment for appendicitis: study

November 14, 2018
Treating appendicitis with antibiotics as an alternative to surgical removal of the inflamed organ was found to be more costly in the long term and result in higher rates of hospital readmissions, according to a study by ...

Study finds that in treating obesity, one size does not fit all

November 13, 2018
Analyzing data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, researchers identified at least four different patient subgroups that diverge significantly in eating behaviors and rate of diabetes, ...

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

November 7, 2018
Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

Minimally invasive surgery associated with worse survival for women with cervical cancer compared to open hysterectomy

October 31, 2018
When comparing standard-of-care surgical options for women with early-stage cervical cancer, two studies led by researchers at The University of Texas MD Anderson Cancer Center discovered that minimally invasive radical hysterectomy ...

Aspirin alone a good clot buster after knee surgery

October 22, 2018
When it comes to preventing blood clots after a knee replacement, good old aspirin may be just as effective as newer, more expensive drugs.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.