Smoking has been shown to interfere with the success of spine and ankle surgeries. Researchers think nicotine restricts the blood supply that bones in these areas need in order to heal. Compared to the spine and ankle, the wrist naturally has a better blood supply. Does smoking also affect the results of wrist surgery?
In this study, the authors compared the results of smokers and nonsmokers who had surgery on the ulna,the bone on the little-finger side of the wrist. The patients had been having problems in the part of the wrist where the end of the ulna meets the hand.
After trying other kinds of treatment such as splints and anti-inflammatory drugs, the patients in the study had osteotomy surgery on the ulna bone. This is a procedure in which a wedge of bone is taken out of the ulna, shortening it. Doctors use a metal plate to connect the two pieces of bone together. When this procedure is successful, the two ends of the ulna grow back together into solid bone. The authors wanted to see whether smokers would have a harder time healing than nonsmokers.
Thirty-nine patients had surgery. Nineteen were smokers. Twenty were not. Compared to nonsmokers, smokers took almost twice as long to heal. The average time for bones to grow back together was 7.1 months for smokers and 4.1 months for nonsmokers.
Smoking also decreased the overall success of the surgery. Six of the smokers showed serious delays in healing (more than seven months) or failed to show any improvement in a year’s time. Meanwhile, none of the nonsmokers had these problems.
This study adds to the already abundant evidence that smoking impairs bone healing. Notably, nicotine works its mischief on bones that are trying to grow together, even in an area with good blood supply. The authors want to find ways to improve bone union for smokers who have wrist surgery. Implanting bone in the wrist or keeping casts on longer after surgery may help patients who smoke get better results from this procedure.