SynthesisBMJ open2016
Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis.
Synthesis in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 85 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
85 citing papers in PubMed, 5 syntheses or guidelines pooled it, 162 citations in OpenAlex.
- The association between smoking and clinical outcomes among spondylodesis patients: A systematic review and meta-analysis.PloS one · 2026Pooled it
- The effects of smoking on the management of scaphoid acute fractures and non-unions-a systematic review.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Pooled it
- Relationship between smoking and postoperative complications of cervical spine surgery: a systematic review and meta-analysis.Scientific reports · 2022Pooled it
- Smoking and Dental Implants: A Systematic Review and Meta-Analysis.Medicina (Kaunas, Lithuania) · 2021Pooled it
- Delayed Tibial Shaft Fracture Healing Associated with Smoking: A Systematic Review and Meta-Analysis of Observational Studies Conducted Worldwide.International journal of environmental research and public health · 2021Pooled it
- Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2020Trial
- Long-term outcomes following scaphoid nonunion surgery: the role of structural severity, avascular necrosis, and surgical timing.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026Article
- Fracture healing: from molecular and cellular mechanisms to therapeutic strategies.Signal transduction and targeted therapy · 2026Review
- The impact of nicotine dependence on postoperative complications following humeral shaft fracture repair.JSES reviews, reports, and techniques · 2026Article
- Cigarette Smoking Was Not Associated With Lower Odds of Radiographic Fusion After Combined TLIF and Posterolateral Lumbar (270°) Arthrodesis: A CT-based Retrospective Cohort Evaluation.Clinical orthopaedics and related research · 2026Article
- Perioperative Management of Patients Undergoing Periacetabular Osteotomy: An Evidence-Based Review.Current reviews in musculoskeletal medicine · 2026Review
- Association between visceral adiposity index and delayed union/nonunion after tibial or femoral shaft fractures: a single-center retrospective cohort study.BMC musculoskeletal disorders · 2026Article
- Outcomes at mean 8-year follow-up after reverse total shoulder arthroplasty for failed fracture treatment.JSES international · 2026Article
- Epidemiology of non-unions following foot and ankle fractures: a nationwide analysis from 2014 to 2023.BMC musculoskeletal disorders · 2026Article
- Six Weeks in Orthopedics: Biological Basis, Clinical Practice, and Evidence for a Universal Benchmark.Orthopedic reviews · 2026Article
- Smoking significantly impairs clinical outcome following anterior cervical radiculopathy surgery.Brain & spine · 2026Article
- Complications, Conversion, and Secondary Procedures Following Minimally Invasive Periacetabular Osteotomy: A Single-Surgeon Case Series.Arthroplasty today · 2025Article
- Time to consider fracture nonunion an orphan disease? An update into pathophysiology, epidemiology and therapeutic solutions.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Review
- Nicotine, tobacco smoking, and pain in orthopedic trauma settings: a conceptual framework for practice and research.Archives of orthopaedic and trauma surgery · 2025Review
- Chest wall soft tissue thickness is associated with humeral shaft non-union: A radiographic study.Shoulder & elbow · 2024Article
25 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesSystematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions.
settingMedical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND
interventionsObservational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES: 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated.
resultsThe search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3).
conclusionsSmokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.