SLR - December 2009 - Priya Parthasarathy
Reference:
Krannitz KW., Fong HW., Fallat LM., Kish J.(2009). The effect of cigarette smoking on radiographic bone healing after elective foot surgery. Journal of Foot Ankle Surgery, 48, 525-527.
Scientific Literature Reviews
Reviewed by: Priya Parthasarathy DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This study attempts to examine the effect of cigarette smoking on bone healing rates following Austin bunionectomy.
Methods:
Forty six patients were evaluated in this prospective study. Patients were divided into 3 groups: 17 smokers, 12 secondhand smokers, and 17 non-smokers. Exclusion criteria were patients that previously had HAV surgery on the same foot, those >70 or <18 years old, patients with the radiographic appearance of osteoporosis, or patients with a diagnosis of either osteoporosis, diabetes or another immunocompromising disease. Inclusion criteria were patients undergoing Austin bunionectomy with internal screw fixation. Nicotine dependence was assessed with the standardized Fagerstrom test and a urine continine test. Post surgical radiographs were used to determine bone healing. Data was assessed using a one-way analysis of variance.
Results:
Post-operative radiographs were evaluated at 3-week intervals by blinded evaluators to determine cortical bridging consistent with consolidation of the osteotomy. The ostetomy of the smokinggroup took 1.73 times longer to reach radiographic bone consolidation than that of the non-smoking group. Healing time after the Austin bunionectomies was 69 days in non-smokers, 120 days in smokers and 78 days in second-hand smokers. Furthermore, a correlation was made between an increased healing time, and higher urine continine and Fagerstrom numbers. Statistically significant Pearson correlation values were found with each of the primary and secondary outcome measures.
Conclusion:
In conclusion, a 42% increase in time to bone healing was found in patients who smoked. The data provided in this study is important for the surgeon and patient to be aware of while considering elective forefoot surgery in a cigarette smoker.