As we have already noted, the tissues of the human body receive less blood and, therefore, less oxygen. Oxygen is essential for all molecular function including the repair of damaged tissue. This is especially true in the manufacture of new bone or osteogenesis which is necessary for fracture healing.
Multiple studies verify a higher incidence of delayed and nonunited fractures among the smoking population. As humans, we heal our broken bones with a preliminary substance, fracture callus. Several studies have compared the microscopic appearance of this material in smokers and nonsmokers. In the smoking population, the fracture callus is poorly organized with loss of continuity.
Thus people who smoke are not only more likely to sustain fractures due to an increase in skeletal fragility, but they are also less likely to repair these fractures in a timely manner.
In orthopedic surgery, it is frequently necessary to operate upon bone, and during the postoperative phase or time period following surgery, bone healing is essential. The orthopedic operations which depend upon the human body to manufacture new bone are more likely to fail among the adults who smoke. These operations include spinal fusion and other procedures which require bone grafting. Other orthopedic procedures such as leg lengthening and newer methods of fracture repair require bone production to fill in the gap, or distraction osteogenesis, are less likely to succeed. Active smoking is now considered a relative contraindication for these operations.
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