The influence of smoking and alcohol on bone healing

Researchers from the Department of Orthopedic Surgery in Seoul, Republic of Korea embarked on a study with the objective of assessing the relationships between smoking, preoperative smoking cessation, nicotine replacement therapy, vaping, alcohol consumption, and the healing of non-pathological fractures in adult patients. It's worth noting that bone fractures impact approximately one in every three individuals during their lifetime, and a notable percentage, ranging from 4% to 9%, do not heal properly, a condition referred to as non-union.
In addition to surgical and conservative treatments for fractures, various studies have recommended preventive strategies to enhance fracture healing rates. For this systematic review, a total of 122 studies encompassing 417,767 patients met the eligibility criteria. The evaluation period for non-union cases spanned six months. Following the treatment of non-pathological fractures, the research revealed a significant disparity in non-union rates between the group of individuals who smoked and those who did not. Interestingly, there was no statistically significant contrast in the non-union rates between individuals who consumed alcohol and those who abstained from it. Moreover, the study identified a noteworthy reduction in the incidence of wound infections after surgery in the group of individuals who ceased smoking prior to the operation, in comparison to those who continued smoking. Consequently, it can be deduced that smoking is closely linked to higher non-union rates and an increased risk of deep surgical site infections. On the other hand, the act of quitting smoking for a duration of four weeks prior to surgery was associated with a notable decrease in the rate of postoperative wound infections, underscoring the importance of preoperative smoking cessation as a beneficial measure in fracture healing.