Distal tibia fractures are one of the most demanding injuries in orthopaedic traumatology, due mainly to frequent coexistence of covering tissue problems and poor blood supply. Smoking exerts a detrimental effect on fracture healing, increasing the time to union. We report the case of a 60-year-old heavy-smoker (about 20 cigarettes a day) with a distal tibia fracture that necessitated synthesis with an external fixator to maximize the healing process, which nevertheless required more than one and half year to heal. We consider this case as a "take-home message" against tobacco use during the treatment of any orthopaedic issue.