The effect of smoking on bone healing

Patel, Rupal; Wilson, R.F.; Patel, Priyal; Palmer, Richard

doi:10.1302/2046-3758.26.2000142

Cited by 180 publications

(104 citation statements)

References 24 publications

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“…It is an independent risk factor across a variety of populations and conditions [5,26,30,42], but specifically associated with delayed healing and recurrence of pain in shoulder [6], back [29], neck [14], and multiple other exercise-related injuries [2]. It has deleterious effects on peak bone mass [8], bone mineral density [43], bone healing [28], and wound healing [4,25] as well as many other general complications [41]. However, the exact nature of this association still needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

Teyhen¹,

Shaffer

Butler

et al. 2015

Clinical Orthopaedics &Amp; Related Research

111

119

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Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy. Understanding intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness. Findings from this population may also be useful as hypothesis-generating work for particular civilian settings such as law enforcement officers (SWAT teams), firefighters (smoke jumpers), or others in physically demanding professions.Questions/purposes The purposes of this study were (1) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk; and (2) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers. Methods Our study was a planned secondary analysis from a prospective cohort examining how baseline factors predict musculoskeletal injury. Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures. Army Physical Fitness Test (consisting of a 2-mile run and 2 minutes of sit-ups and push-ups). A total of 320 Rangers were invited to enroll and 211 participated (66%). Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys, medical record reviews, and a query of the Department of Defense healthcare utilization database. Injury surveillance data were available on 100% of the subjects. Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest. A logistic regression equation was then calculated to find the most pertinent set of predictors. Of the 188 Rangers (age, 23.3 ± 3.7 years; body mass index, 26.0 ± 2.4 kg/m 2 ) remaining in the cohort, 85 (45.2%) sustained a musculoskeletal injury of interest. Results Smoking, prior surgery, recurrent prior musculoskeletal injury, limited-duty days in the prior year for musculoskeletal injury, asymmetrical ankle dorsiflexion, pain with Functional Movement Screen clearing tests, and decreased performance on the 2-mile run and 2-minute situp test were associated with increased injury risk. Presenting with one or fewer predictors resulted in a sensitivity of 0.90 (95% confidence interval [CI], 0.83-0.95), and having three or more predictors resulted in a specificity of 0.98 (95% CI, 0.93-0.99). The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 (95% CI, 2.0-9.2), relative risk of 1.9 (95% CI, 1.4-2.6), and an area under the curve of 0.64. Conclusions Multiple factors (musculoskeletal injury history, smoking, pain provocation, movement tests, and lower scores on physical performance measures) were associated with individuals at risk for musculoskeletal injury. The summation of the number of risk factors produced a highly sensitive (one or less factor) and specific (three o...

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Section: Discussionmentioning

confidence: 99%

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

Teyhen¹,

Shaffer

Butler

et al. 2015

Clinical Orthopaedics &Amp; Related Research

111

119

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“…Fracture union is dependent on a huge number of different variables. [57,58]. All the studies evaluated were of poor study design, with no fixed definition of union and none used a validated radiological scoring system for bone union, such as the RUST Score [59,60].…”

Section:  Non-union In Closed Fracturesmentioning

confidence: 99%

Fracture management in HIV positive individuals: a systematic review

Wijesekera

Graham

Lalloo

et al. 2016

International Orthopaedics (SICOT)

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Purpose: Human immunodeficiency virus (HIV) infection could potentially play an important role in the management of fractures as they have been shown to affect fracture healing and the post-operative risk of implant sepsis.Methods: A systematic review of the relevant literature was performed on PubMed and Scopus databases. Twenty-six studies were identified, critiqued and analysed accordingly. No randomised controlled trials were identified.Results: HIV positivity was not shown to influence an individual's risk of early wound infection in operatively managed closed fractures. Thank you for your kind comments on our unique systematic review. We have responded to the reviewers and made the changes suggested. Authors' response Many thanks for your comments. The suggested references however interesting, does not seem to cater to this population of interest. The suggested first article focusses on myocardial complications in those undergoing arthroplasty. The second suggested article main emphasis is on spinal trauma and does not refer to the HIV population. Thus we have decided not to go forth inserting these references and no further actions were taken. We do think that these articles are useful and may be included in a future study.Reviewer #2: This is a nice review paper suggesting the well-known fact that there is a place in HIV patients to surgical fixation of fractures.However the authors should: 1) Explain in the "Introduction" and in the "Discussion" the meaning of ART and the new development in this mode of treatment and describe the change in morbidity and mortality in HIV patients" in the last few years and the relation of this change to their findings Authors' response Many thanks for your comments. We agree that a further explanation on ART should be included to the reader. This was included in the "Introduction." Clarification on the morbidity and mortality reduction since the introduction of ART in HIV infected patients was also included. Regarding discussing the new developments in ART, this is a whole topic in itself and beyond the scope of this review. However, we are currently finalising a similar systematic review focusing on the effect of ART on bone metabolism and fracture healing which we will submit for consideration for publication in your journal soon. Authors' action Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationThe following changes have been made; The introduction of Anti-Retroviral Therapy (ART) in 1997 altered the course and nature of patients infected with HIV by increasing the duration of asymptomatic infection and increasing life expectancy [2,3]. ART is a combination of medication given to those affected with the disease. This suppresses the viral load and improves the patient immunological status [4]. A 50% reduction in morbidity and mortality has been reported in those with a CD4 T-cell count of >500cells/mm3 and have been started on ART promptly [5,6]. However, despite near normal life expectancy, there is little evidence to...

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“…We also collected information on body mass index (BMI) -calculated from height and weight as reported by the patient -and smoking status, which may be correlated with a longer hospitalization as it is associated with medical complications. 19,20 Injury severity characteristics included isolated trauma or polytrauma, upper limb involvement, open or closed fracture, trauma associated with head injury, surgical versus conservative treatment, trauma above or below the knee, time between injury and hospital admission and time between admission and surgery. Socioeconomic status was characterized by employment status (unemployed, employed, retired, autonomous worker, student, other), marital status (married, divorced, single, widower) and patient insurance (none, provincial automobile insurance plan, workers compensation, private insurance).…”

Section: Methodsmentioning

confidence: 99%

Rehabilitation after lower limb injury: development of a predictive score (RALLI score)

Rouleau

Place

Bérubé³

et al. 2015

cjs

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Background:The purpose of our study was to identify the risk factors associated with the need for inpatient rehabilitation after lower limb injury to develop a predictive scoring tool for early identification of such patients. Methods:We followed a prospective cohort of patients admitted to a level 1 trauma centre. Data were collected through chart review and a self-administered questionnaire on sociodemographics, patient living environment, pretrauma status, injury and treatment received. We compared patients who were discharged home with those going to rehabilitation after acute care. Analysis consisted of bivariate comparisons and logistic regression. Results:Our study included 160 patients with a mean age of 56 years. A total of 40% were discharged to an inpatient rehabilitation centre. Factors associated with inpatient rehabilitation were low preinjury physical health status, concomitant injury of the upper limbs, bilateral lower limb injury, the use of a walking aid before injury, head injury and femur or pelvic fractures. We created a predictive score using the top 3 risk factors: upper limb injury, bilateral lower limb injury and presence of femoral or pelvic fractures. The chance of needing inpatient rehabilitation rose from 14% with 0 factors to 47% with 1 factor and 96% with 2 factors.

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The effect of smoking on bone healing

Cited by 180 publications

References 24 publications

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study

Fracture management in HIV positive individuals: a systematic review

Rehabilitation after lower limb injury: development of a predictive score (RALLI score)

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