Cigarette smoking and open tibial fractures

Injury. 2001 Jan;32(1):61-5. doi: 10.1016/s0020-1383(00)00121-2.


Complication rates were compared in 140 smoking and 133 non-smoking patients with open tibial fractures. Both the groups were evenly matched demographically and in terms of primary fracture treatment. Flap failure complicated 7 (20%) patients in the smoking group and 4 (14%) in the non-smoking group. The mean time to union was 32 weeks for smokers and 28 weeks for non-smokers (P<0.05). Bone grafting to stimulate union was required in 36 (26%) smoking patients compared with 24 (18%) non-smoking patients. In patients treated by intramedullary nailing exchange, nailing to achieve union was carried out in 24 (38%) smoking cases compared with 13 (26%) of non-smoking cases. Smoking is associated with an increased risk of complications in patients with open tibial fractures. There is an increased rate of flap failure, delayed union and non-union. We recommend patients with open tibial fractures should be advised to stop smoking to minimise these complications.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fracture Fixation, Intramedullary
  • Fracture Healing
  • Fractures, Open / complications*
  • Fractures, Open / surgery
  • Fractures, Ununited / etiology
  • Humans
  • Male
  • Middle Aged
  • Smoking / adverse effects*
  • Surgical Flaps / standards
  • Tibial Fractures / complications*
  • Tibial Fractures / surgery
  • Treatment Failure
  • Wound Infection / etiology