ReviewEFORT open reviews2021
Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis.
Review in EFORT open reviews, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 3 of them syntheses that pooled it.
What it found
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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.
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Who cites it
31 citing papers in PubMed, 3 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Risk prediction models for postoperative infections in patients with hip fractures: a systematic review and critical appraisal.Frontiers in medicine · 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
- Examining the role of smoking on clinical outcomes after arthroscopic surgery of the hip: a systematic review and meta-analysis.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Pooled it
- Surgical Fixation Versus Cast Immobilization for Adults With Bicortical Scaphoid Fractures: A Target Trial Emulation of the SWIFFT Trial.The Journal of the American Academy of Orthopaedic Surgeons · 2026Article
- Let's Be Realistic with Rurality: Timely Surgical Management of Open Fractures in Rural and Remote Patients.Journal of clinical medicine · 2026Article
- Strategic considerations in the treatment of infected nonunion in the lower extremity: a narrative review.International journal of surgery (London, England) · 2026Article
- Risk factors for reoperation following operative fixation of patella fractures.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Short-term complications of open reduction and internal fixation of olecranon fractures: a national database study.JSES international · 2025Article
- Development and validation of a nomogram model for predicting postoperative nonunion in femoral shaft fractures.BMC musculoskeletal disorders · 2025Article
- Article
- Surgical Management of Osteoporotic Fractures: Humerus Shaft Fractures.Indian journal of orthopaedics · 2025Review
- Smokers present a three times higher risk of graft failure after ACL reconstruction: A single-centre retrospective analysis.Journal of experimental orthopaedics · 2025Article
- A Small Ratio of Proximal to Distal Bone Fragments Is a Risk Factor for Scaphoid Nonunion: A Volumetric Analysis of Preoperative CT.Journal of wrist surgery · 2025Article
- High rate of failure after magnesium bioabsorbable compression screw fixation for scaphoid fractures.Journal of orthopaedic surgery and research · 2025Article
- Identification of clinical risk factors and optimal inflammatory marker cutoffs for the diagnosis of septic nonunion at time of presentation.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity?Hand (New York, N.Y.) · 2025Article
- Following Multiple Failed Reconstructions of a Distal Femur Fracture, Osseous Union Achieved After Superficial Femoral Artery Endarterectomy.Ochsner journal · 2025Article
- Risk factors for Implant Failure in Thoracolumbar Fractures Treated with Posterior Long-Segment Instrumentation.Clinics in orthopedic surgery · 2024Article
- A Scoring System for Predicting Nonunion After Intramedullary Nailing of Femoral Shaft Fractures.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis.EFORT open reviews · 2024Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients.A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins' I2, publication bias with Harbord's p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale.Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%).Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections. Cite this article:
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