Cigarette smoking delays bone healing: a prospective study of 200 patients operated on by the hemicallotasis technique.

Background: Cigarette smoking is known to impede bone healing. The hemicallotasis technique is based on an external fixation and delayed healing prolongs treatment and increases the risk of further complications.

Patients and methods: 200 patients, 34 smokers and 166 nonsmokers, operated on by the hemicallotasis technique in the proximal tibia for deformities of the knee (knee arthrosis in 186 patients) were consecutively studied. We recorded their preoperative smoking habits, postoperative complications and the duration of treatment with external fixation.

Results: Half of the smokers and one fifth of the nonsmokers developed complications. Their mean time in external fixation was 96 (SD 20) days. Smokers required an average of 16 days more in external fixation. Delayed healing and pseudoarthrosis were commoner in smokers than nonsmokers. The risk ratio for smokers to develop complications was 2.5, as compared to nonsmokers.