Tibial fractures

Summary

Evidence from five cohort studies suggest that smoking is associated with higher rates of delayed and nonunion, longer time to union, and greater requirement for secondary surgery to stimulate union following tibia fracture. Smokers also tended to have higher rates of complication (eg, flap failure and infection), but none of the reported differences in serious complications achieved statistical significance. Discrepancies in follow-up rates for smokers compared with nonsmokers should be considered when interpreting results, as should differences in criteria for ascertainment of union.