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Smoking is associated with delayed bony healing following ulnar shortening osteotomy
Patrick M. Kane, MD; Michael P. Gaspar, MD; Raphael C. Zohn, BS; Taylor Buckley, MD; Sidney M. Jacoby, MD; Eon K. Shin, MD
Philadelphia Hand Center, Philadelphia, PA

Introduction: The purpose of this study is to evaluate for an association between smoking and time to bony union following ulna shortening osteotomy using a dedicated osteotomy plating system.
Methods: We retrospectively reviewed the charts of consecutive patients who underwent ulnar shortening osteotomy over a five year span using a single osteotomy dynamic compression plating system. Orthogonal radiographs were analyzed by a blinded reviewer to determine time to bony union at monthly intervals. Bivariate statistical analysis with independent t-test was utilized for comparing time to union (in months) for dichotomous explanatory variables (gender, smoking status, alcohol use and hand dominance). Pearson correlation was used to analyze continuous variables (age, BMI and number of cigarettes smoked daily) relative to time to union.
Results: Seventy-two ulna-shortening osteotomies were performed in 69 patients, including 42 females and 27 males. Average age at the time of surgery was 44.2 +/- 12.2 years. 40 surgeries were performed on the dominant extremity. 17 cases were in smokers and 55 in non-smokers. The average time to union was 4.0 +/- 2.2 months for the entire cohort; time to union for smokers was 6.3 +/- 2.8 vs. 3.3 +/- 1.3 months in non-smokers (p < .001). Delayed union, defined as 6 months to union, occurred in 7 smokers and 1 former smoker with a history of Type II Diabetes There were 4 revision surgeries for nonunion and hardware failure 3 in smokers and 1 in a non-smoker. Revisions in smokers occurred at 2, 6 and 10 months. The revision in the non-smoker occurred at two months due to distal screw loosening. This patient had a known history of cerebral palsy and admitted to weight bearing through her arm for ambulation in the post-operative period. Hardware removal was performed in 13/72 (18%) of cases. Other complications included CRPS Type I in 1 patient and granuloma formation at the incision site in 1 patient which required excision. There were no post-operative infections. Gender, BMI and number of cigarettes smoked daily did not affect time to bony union. Time to union in diabetics was 5.1 +/- 2.5 months vs 3.9 +/- 2.1 months in non-diabetics, but this was not statistically significant (p = .23).
Conclusions: Despite the use of osteotomy-specific plating systems, smokers were found to be at higher risk for both delayed union and nonunion, the latter of which required revision surgery.

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