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Updated: May 14, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Smoking as a predictor of negative outcome in diaphyseal fracture healing
Jacques Hernigou1, Frédéric Schuind
1Department of Orthopaedics and Traumatology, Erasme University Hospital, 808, route de Lennik, 1070, Brussels, Belgium. jacques.hernigou@ulb.ac.be
Purpose:
The purpose of this study was to evaluate the impact of tobacco abuse in the consolidation of fractures.
Methods:
We retrospectively identified all patients with a diaphyseal fracture (femur, tibia, or humerus), between January 1999 and December 2010, in our orthopaedic trauma registry (Erasme hospital, Brussels, Belgium). Thirty-eight diaphyseal nonunions (ten femurs, 16 tibias and 12 humerus) were identified. Each nonunion was paired (on age, sex and location) with two control-healed fractures (76 control patients). The chi-squared test and a binary logistic regression were used for statistical analysis.
Results:
In multivariate analysis, smoking (tobacco use) was significantly associated with nonunion, whether the fracture was open or closed (p < 0.01). In univariate analysis, open fracture was associated with a higher risk of nonunion (p < 0.05), while external fixation was associated with better bone healing (p < 0.05).
Conclusion:
Tobacco is confirmed as a deleterious factor for diaphyseal bone healing.
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