ARE SMOKERS A RISK GROUP FOR DELAYED HEALING OF TIBIAL SHAFT FRACTURES

A total of 135 patients with a fresh tibial shaft fracture and with no other significant injuries underwent primary conservative treatment. Data on their smoking habits were obtained from hospital records and b y questionnaire. Although the smokers had better prospects for healing of the fracture at the outset than non-smokers (lower mean age and le ss fractures caused by high-energy injuries), the smokers were found t o have a significantly longer mean time to clinical union and a higher incidence of delayed union. According to a crude calculation, smokers had a 4.1-fold risk of tibial shaft fracture caused by low-energy inj ury, compared with non-smokers. An accelerated failure time model show ed that the more comminuted or open the fracture, the higher the numbe r of cigarettes smoked and the older the patient, the longer was the t ime to clinical union of the tibial shaft fracture. Female sex appeare d to be a further risk factor for delayed healing. A logit model indic ated that comminution of the fracture, smoking and female sex were ass ociated with delayed union and non-union. If a patient has a markedly raised probability of delayed union of tibial shaft fracture because o f many risk factors as reported in the previous literature or in this study, operative treatment should be considered as the primary alterna tive instead of conservative treatment. Stopping smoking during healin g of tibial shaft fracture could also promote the union of the fractur e.