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Failure of Surgery for Scaphoid Non-Union is Associated with Smoking

From the Nuffield Orthopaedic Centre, Headington, Oxford, UK

Correspondence: Corresponding author. Mr Peter Burge, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7BD, UK. Tel: +44 1865 741155; fax: +44 1865 227740. E-mail: peter.burge{at}ndos.ox.ac.uk

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3–10.1, p = 0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

Key Words: scaphoid • non-union • smoking • bone graft • fixation

Journal of Hand Surgery (British and European Volume), Vol. 31, No. 3, 252-255 (2006)
DOI: 10.1016/J.JHSB.2005.12.010


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