No you cannot smoke if you have a fracture, this is why?
Smokers have a 40% increased time to union and chance of non- union compared with non-smokers.(1)
Me: when did you quit smoking?
Ali: 1 week ago.
Me: when did you have the fracture?
Ali: 1 week ago.
This is a very usual conversation at my clinic!
4 ways smoking affects your fracture.(2)
Delays bone union.
Decreases bone mineral density( meaning makes your bones softer)
Delays wound healing.
Increases chances of non union, meaning your fracture may not unite.
The risk of nonunion in smokers is 2.2 times non smokers.
Nicotine in the cigarette selectively stimulates the osteoclast cells which help in breaking down the bone and inhibits the osteoblast cells which help in bone formation.(3)
Tip:
STOP SMOKING!. Smokers should abstain from smoking till complete fracture union.
Reference:
Pearson RG, Clement RG, Edwards KL, Scammell BE. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open. 2016 Nov 14;6(11):e010303. doi: 10.1136/bmjopen-2015-010303. PMID: 28186922; PMCID: PMC5129177.
Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M. The effects of smoking on fracture healing. Surgeon. 2010 Apr;8(2):111-6. doi: 10.1016/j.surge.2009.10.014. Epub 2010 Feb 4. PMID: 20303894.
Hollinger, J.O., Schmitt, J.M., Hwang, K., Soleymani, P. and Buck, D. (1999), Impact of nicotine on bone healing. J. Biomed. Mater. Res., 45: 294-301. https://doi.org/10.1002/(SICI)1097-4636(19990615)45:4<294::AID-JBM3>3.0.CO;2-1
Xu B, Anderson DB, Park ES, Chen L, Lee JH. The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures. EClinicalMedicine. 2021 Oct 31;42:101179. doi: 10.1016/j.eclinm.2021.101179. PMID: 34765953; PMCID: PMC8571530.
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