Evidence map›Paper›PMID 34765953›Full record

ArticleEClinicalMedicine2021

The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures.

Bin Xu, David B Anderson, Eun-Sun Park, Lingxiao Chen, Jae Hyup Lee

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. 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 · 2025
    Pooled it
  5. Conservative treatment versus transverse pinning in fifth metacarpal neck fractures in active adults: a randomized controlled trial.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024
    Trial
  6. Article
  7. Enhancing Bone Healing with a Priming Stimulus.Life (Basel, Switzerland) · 2026
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  10. Effects of paraspinal muscle atrophy and fatty degeneration on segmental kyphosis after conservative treatment of osteoporotic vertebral compression fracture (OVCF) in postmenopausal women.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Bin XuDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.
David B AndersonFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Eun-Sun ParkMedical Library, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Lingxiao ChenInstitute of Bone and Joint Research, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Jae Hyup LeeDepartment of Orthopedic Surgery, College of Medicine, Seoul National University, Seoul, Republic of Korea.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe aimed to comprehensively evaluate the associations between (i) smoking, (ii) preoperative smoking cessation time, (iii) nicotine replacement therapy (NRT), (iv) vaping, and (v) alcohol consumption and non-pathological fracture healing in adult patients. We also assessed the impacts of preoperative smoking cessation time, NRT, and vaping on wound healing and wound complications after any sort of surgery.

methodsWe searched the MEDLINE, Embase, Cochrane CENTRAL, CINAHL, and AMED electronic databases from their inceptions until August 9th, 2021. Primary outcomes included delayed union rate, nonunion rate, and time to union. A random effects model was used. (Protocol registration: PROSPERO-CRD42019131454).

findingsOne hundred and twenty-two studies with 417,767 patients were eligible for the systematic review and 71 of the studies with 39,920 patients were eligible for the meta-analysis. After non-pathological fracture treatment, the nonunion rate was significantly greater in the smoker group than in the non-smoker group (odds ratio [OR], 2·50, 95% confidence interval [1·73-3·61]); additionally, there was no significant difference in the nonunion rate (OR, 0·97 [0·40-2·38]) between the alcohol drinker group and the non-drinker group. The rate of wound infection after surgery was significantly reduced in the smoking cessation group (≥four weeks before surgery) compared to the continuous smoker group (OR, 0·37 [0·16-0·89]).

interpretationSmoking is associated with higher rates of nonunion and deep surgical site infection after non-pathological fracture treatment. Smoking cessation (≥four weeks before surgery) is associated with a decreased rate of postoperative wound infection.

fundingThe China Scholarship Council (no. 201809120013).

Indexed as

Alcohol consumptionBone healingMeta-analysisSmokingWound healing

Identifiers

PMID34765953
PMCPMC8571530

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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.