The Healing Time of Closed Femoral Shaft Fractures in Smokers and Non-Smokers Following Open Reduction and Internal Fixation with Plate and Intramedullary Nail

Abstract Non-union or delayed union after long bone fracture surgery is very common. This study aimed at evaluating the healing time of closed femoral shaft fractures in smokers and non-smokers following open reduction and internal fixation with plate and intramedullary nailing. In a cohort study, patients were divided into two groups of smokers and non-smokers with closed transverse fracture of the femoral shaft bone. The patients who smoked 6 or more cigarettes per day were considered as smoker. Treatment method was based on the patient's preference and not based on being smoker or not. Patients were followed up for one year for clinical and radiological examinations on the status of the union. The collected data were analyzed using SPSS software version 19. In our study, 220 patients were studied (110 smokers and 110 non-smokers). Most of the patients with closed femoral shaft fractures were men (79.7%). Their mean age was 32.78± 16.93 years. There was a statistically significant relationship between the bone healing in treatment with plate and intramedullary nailing in smokers (P = 0.004). All non-smokers had union (100%), 74.1% in the group treated with plate had union and 78.8% in the group treated with intramedullary nailing had union, respectively (P = 0.234) 180 days after surgery. There was also a statistically significant association between delayed union in plate treatment and intramedullary nailing in patients who smoked (P = 0.04). The treatment and daily function of smokers is usually worse than non-smokers and needs longer follow-up. It seems that the intramedullary nailing in smokers with closed femoral shaft fracture leads to more delayed union.