Abstract
The aim of the study was to investigate the effect of smoking on the operative treatment of established non-union of the carpal scaphoid. Case notes and radiographs of patients undergoing bone grafting and screw fixation of scaphoid non-unions were reviewed. There were 34 patients that had undergone 37 operations for established non-union of the carpal scaphoid bone. There were two female patients, and the average age was 26.8 years (range 13.4 years to 52.9 years). The median delay to operation was 11.9 months. The overall success rate of the operation (internal fixation and autologous bone grafting) was 59.5% (22/37), but there was a significant association between non-union and smoking (P=0.02 for Fisher’s exact test). In non-smokers (n=17) the success rate was 82.4%, but this dropped to 40.0% among smokers (P<0.01). We concluded that smoking was significantly associated with failure of operative treatment of established non-union of the scaphoid bone.
Résumé
Le but de cette étude est d’évaluer les effets de la cigarette dans le traitement chirurgical des pseudarthroses du scaphoïde carpien. Méthode nous avons revu les dossiers cliniques et radiographiques des patients devant bénéficier d’une greffe et d’un vissage pour une pseudarthrose du scaphoïde. Résultats : 34 patients ont bénéficié de 37 opérations pour une pseudarthrose du scaphoïde carpien. Il s’agissait de deux sujets de sexe féminin, les autres patients étant de sexe masculin, la moyenne d’âge étant de 26,8 ans (13.4 à 52.9). Le délai moyen de réintervention a été de 11.9 mois. Le taux de bons résultats (fixation interne et greffe autologue) a été de 59.5% (22/37) mais il a été mis en évidence une relation significative entre le taux de pseudarthrose et le nombre de sujets fumeurs (p=0.02 thèse de Fisher). Chez les sujets non fumeur, n=17, le taux de succès a été de 82.4%, alors qu’il n’est que de 40% chez les fumeurs. En conclusion, la cigarette peut être associée avec un taux d’échec du traitement chirurgical des pseudarthroses du scaphoïde.
Similar content being viewed by others
References
Adams CI, Keating JF, Court-Brown CM (2001) Cigarette smoking and open tibial fractures. Injury 32:61–65
Christodoulou LS, Kitsis CK, Chamberlain ST (2001) Internal fixation of scaphoid non-union: a comparative study of three methods. Injury 32:625–630
Davies HTO, Crombie IK, Tavakoli M (1998) When can odds ratios mislead? BMJ 316:989–991
Dias JJ, Brenkel IJ, Finlay DBL (1989) Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br 71:307–310
Filan SL, Herbert TJ (1996) Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br 78:519–529
Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, MacDonald DA, Smith RM (1999) Exchange nailing for femoral shaft aseptic non-union. Injury. 30:245–249
Gelberman RH, Wolock BS, Siegel DB (1989) Fractures and non-unions of the carpal scaphoid. J Bone Joint Surg Am 71:1560–1565
Inoue G, Shionoya K, Kuwahata Y (1997) Herbert screw fixation for scaphoid nonunions. An analysis of factors influencing outcome. Clin Orthop Relat Res 343:99–106
Kyro A, Usenius JP, Aarnio M, Kunnamo I, Avikainen V (1993) Are smokers a risk group for delayed healing of tibial shaft fractures? Ann Chir Gynaecol 824:254–262
London PS (1961) The broken scaphoid: the case against pessimism. J Bone Joint Surg Br 43:237–244
Nakamura R, Horii E, Watanabe K, Tsunoda K, Miura T (1993) Scaphoid non-union: factors affecting the functional outcome of open reduction and wedge grafting with Herbert screw fixation. J Hand Surg [Br] 18:219–224
Nolte PA, van der Krans A, Patka P, Janssen IM, Ryaby JP, Albers GH (2001) Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 51:693–702; discussion 702–703
Schmitz MA, Finnegan M, Natarajan R, Champine J (1999) Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res 365:184–200
Trumble TE, Clarke T, Kreder HJ (1996) Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 78:1829–1837
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dinah, A.F., Vickers, R.H. Smoking increases failure rate of operation for established non-union of the scaphoid bone. International Orthopaedics (SICO 31, 503–505 (2007). https://doi.org/10.1007/s00264-006-0231-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-006-0231-7