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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 165

Effects of Smoking on Healing of Distal Femur Intra-articular Fractures, Treated with Distal Femur Locking Compression Plate


Department of Orthopaedics, Military Hospital, Siliguri, West Bengal, India

Date of Web Publication28-Dec-2020

Correspondence Address:
Dr. Bhanu Sharma
Department of Orthopaedics, Military Hospital, Bagdogra, Siliguri, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_32_18

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How to cite this article:
Sharma B. Effects of Smoking on Healing of Distal Femur Intra-articular Fractures, Treated with Distal Femur Locking Compression Plate. J Orthop Traumatol Rehabil 2020;12:165

How to cite this URL:
Sharma B. Effects of Smoking on Healing of Distal Femur Intra-articular Fractures, Treated with Distal Femur Locking Compression Plate. J Orthop Traumatol Rehabil [serial online] 2020 [cited 2021 Jan 20];12:165. Available from: https://www.jotr.in/text.asp?2020/12/2/165/305083



Sir,

I have read the original article entitled “Effects of Smoking on Healing of Distal Femur Intraarticular Fractures, Treated with Distal Femur Locking Compression Plate” by Rajeev Shukla, Nikhil Jain, Ravikant Jain, and Mudit Baxi published in the Journal of Orthopaedics, Traumatology and Rehabilitation, 2018;10:54-6. I want to congratulate the authors for this successful article and make some contributions.

In the article, it has been indicated that a person was called smoker who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes as per the NHIS Guidelines. Furthermore, the authors were unable to analyze the effect of duration and smoking pack size on the radiological union time and other complications.

I think that bone healing is a complex process that is influenced by biological, mechanical, and systemic factors. There is growing evidence that smoking delays or inhibits bone healing after surgery or trauma. This evidence has largely been derived from animal studies and human studies focusing on spinal fusion.[1] Therefore, these factors should be included at baseline whether comparable or not.

In most of the earlier studies, patients are categorized based on self-reported smoking status which can be unreliable, as the duration and magnitude of smoking exposure will have a greater impact on healing.[2] Biochemical analysis is the gold standard of assessing smoking status. This can be achieved by measurement of systemic levels of cotinine which provides the most accurate assessment of the level of exposure of current smoking status.[3] In one study, a urine cotinine test was performed on patients preoperatively and during the postoperative healing period. It involved a urine dipstick, with the strip changing color depending on the concentration of cotinine in the urine. The results showed a correlation between the concentration of cotinine in the urine and the time to healing to confirm smoking status with a biochemical analysis.[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sloan A, Hussain I, Maqsood M, Eremin O, El-Sheemy M. The effects of smoking on fracture healing. Surgeon 2010;8:111-6.  Back to cited text no. 1
    
2.
Scott DA, Palmer RM, Stapleton JA. Validation of smoking status in clinical research into inflammatory periodontal disease. J Clin Periodontol 2001;28:715-22.  Back to cited text no. 2
    
3.
Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health 1987;77:1435-8.  Back to cited text no. 3
    
4.
Krannitz KW, Fong HW, Fallat LM, Kish J. The effect of cigarette smoking on radiographic bone healing after elective foot surgery. J Foot Ankle Surg 2009;48:525-7.  Back to cited text no. 4
    




 

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