Purpose
The purpose of this study was to evaluate the relationship between smoking and delayed
radiographic union after hand and wrist arthrodesis procedures. We hypothesized that
smoking would be associated with a higher rate of delayed union.
Methods
All cases of hand or wrist arthrodesis procedures in patients aged ≥18 years from
2006 to 2020 were identified. Cases were included if they had >90 days of radiographic
follow-up or evidence of union before 90 days. Baseline demographics were recorded
for each case including smoking status at the time of surgery. Complications were
recorded and all postoperative radiographs were reviewed to assess for evidence of
delayed union (defined as lack of osseous union by 90 days after surgery). We compared
active smokers and nonsmokers and performed a logistic regression analysis to estimate
the odds of experiencing a delayed radiographic union.
Results
A total of 309 arthrodesis cases were included and 24% were active smokers. Overall,
radiographic evidence of a delayed union was found in 17% of cases. Smokers were significantly
more likely to have a delayed union compared with nonsmokers (27% vs 14%). Results
of the adjusted logistic regression analysis demonstrated that there was a significantly
increased odds of experiencing a delayed union for patients who were active smokers
compared with nonsmokers (odds ratio, 2.20; 95% confidence interval, 1.09–4.43). In
addition, the rate of symptomatic nonunion requiring reoperation was higher in smokers
(15%) compared with nonsmokers (6%).
Conclusions
Smoking was associated with increased odds of delayed radiographic union in patients
undergoing hand and wrist arthrodesis procedures. Patients should be counseled appropriately
on the risks of smoking on bone healing and encouraged to abstain from nicotine use
in the perioperative period.
Type of study/level of evidence
Prognostic II
Key Words
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Article info
Publication history
Published online: August 04, 2022
Accepted:
May 25,
2022
Received:
November 8,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand.
