Smoking Increases Post-Operative Complications after Distal Radius Fracture Fixation: a Review of 543 Patients From a Level 1 Trauma Center
Daniel Edward Hess, MD; S. Evan Carstensen, MD; Spencer Moore, MD; Angelo Rashard Dacus, MD; University of Virginia, Charlottesville, VA
Introduction: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to impact bone healing and implant fixation rates. The purpose of the study was to evaluate the post-operative complication rates of operative distal radius fractures in active smokers.
Methods: A retrospective review was performed of all patients who were treated operatively for distal radius fractures at a Level 1 trauma center between January 2010 and April 2015 based on CPT codes. Each chart was reviewed for basic demographic information, comorbidities (smoking status, diabetes mellitus (DM), and body mass index (BMI)), details about the operative procedure, and early complications. Notable physical exam findings were also noted such as wrist stiffness, wrist flexion and extension, and distal radius tenderness to palpation. Statistical analysis was performed to evaluate for statistical significance of complications, odds ratios, 95% confidence intervals in the smoking and non-smoking groups. To control for confounding differences in the smoking and non-smoking groups a hierarchical multivariate regression analysis was also performed. P <0.05 was considered significant.
Results: Five-hundred and forty-three patients underwent open reduction and internal fixation of distal radius fractures during the study period queried. The average age was 48.85(+/- 17.65) years and 56.2% were female. Average follow-up was 5.76 months. One-hundred and thirty-two of 543 (24.3%) were current smokers at the time of surgery. The overall complication rate for smokers was 10.51%. The smoking cohort, overall, showed significantly higher rates of hardware removal (p = 0.004), nonunion (p = 0.004), revision procedures (p = 0.011), wrist stiffness (p = 0.004), and distal radius tenderness (p < 0.00). When controlling for the confounding variables of diabetes and BMI, smokers still had significantly higher rates of clinically significant distal radius tenderness and wrist stiffness (p < 0.000 and p = 0.047, respectively) and nonunion (p = 0.042). Smokers trended towards higher rates of revision procedures (p = 0.105) and hardware removal (p = 0.111).
Conclusion: Patients who smoke have a statistically significant higher rate of post-operative distal radius tenderness, wrist stiffness, and nonunion, while trending towards higher rates of hardware removal and revision procedures compared to those who do not smoke in a review of 543 total patients undergoing surgical fixation for distal radius fractures.
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