Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know
Open accessAbstract
Objectives: The aim of this study was to review the impact of smoking tobacco on the musculoskeletal system, and on bone fractures in particular. Methods: English-language publications of human and animal studies categorizing subjects into smokers and nonsmokers were sourced from MEDLINE, The Cochrane Library, and SCOPUS. This review specifically focused on the risk, surgical treatment, and prevention of fracture complications in smokers. Results: Smokers have an increased risk of fracture and experience more complications with delayed bone healing, even if they have already stopped smoking, because some adverse effects persist for a prolonged period. Some risks can be reduced during and after surgery by local and general prevention, and smoking cessation is an important factor in lessening this risk. However, if a patient wants to stop smoking at the time of a fracture, the cessation strategies in reducing tobacco use are not easy to implement. The patient should also be warned that using e-cigarettes or other tobaccos does not appear to reduce adverse effects on health. Conclusion: The evidence reviewed in this study shows that smoking has a negative effect in terms of the risk and treatment of fractures. Cite this article: J. Hernigou, F. Schuind. Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone Joint Res 2019;8:255–265. DOI: 10.1302/2046-3758.86.BJR-2018-0344.R1.
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Inhalation of the mixture of components present in tobacco smoke has negative effects on the immune system, both locally and peripherally.
“In fact, the inhalation of the mixture of components present in tobacco smoke has negative effects on the immune system, both locally and peripherally [50].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [50]
Smoking promotes infection of surgical wounds, and this complication appears related to nicotine and carbon monoxide.
“Smoking is known to promote the infection of surgical wounds; this complication appears to be related to nicotine and carbon monoxide (CO), which are the main substances predisposing patients to wound infection [50].”
From Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic (2021) · cites this paper as [50]
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- Authors
- Hernigou, J., & Schuind, F.
- Affiliations
- Epicura (BE)
- Erasmus Hospital (BE)
- Corresponding author
- Hernigou, J.
- Venue
- Bone & Joint Research
- Published
- 2019-06
- Volume
- 8
- Issue
- 6
- Pages
- 255-265
- ISSN
- 2046-3758 (ISSN-L)
- PMC
- PMC6609869
- OpenAlex
- W2955580883
- Cited by
- 109
- References
- 147
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 23 · 2023: 15 · 2022: 15 · 2021: 14 · 2020: 10
- FWCI
- 7.42
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Bone and Joint Research (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- smoking, tobacco use, bone fractures, fracture risk, delayed bone healing, fracture complications, smoking cessation, electronic cigarettes, fracture surgery
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