Arch Hand Microsurg.  2021 Sep;26(3):141-151. 10.12790/ahm.21.0106.

The Effect of Smoking on the Outcomes of Vascularized Bone Graft Surgery in Scaphoid Nonunion through Meta-analysis

• Kwon YW
• Kim DH

• KMID: 2519466
• DOI: http://doi.org/10.12790/ahm.21.0106

Abstract

Purpose
A vascularized bone graft is an option showing a good result to treat scaphoid nonunion. The analysis of the effects of smoking, which affects vascular and union of fracture, has been limited. We tried to analyze the effect of smoking on the outcomes of vascularized bone graft in scaphoid nonunion through meta-analysis
Methods
Two researchers analyzed 923 papers searched for ‘scaphoid AND (vascularized OR vascularised OR flap OR pedicled)’ on MEDLINE and Embase (until November 2020). We selected 31 papers which contain that vascularized bone graft was performed for scaphoid nonunion, and the number or proportion of smokers could be confirmed. Through meta-regression analysis and subgroup analysis, whether the smoker’s rate had an effect on union rate, union period, functional score, imaging evaluation, range of motion, and complications rate was analyzed
Results
A significant negative correlation between smoking and bone union rate was confirmed in pedicled vascularized bone grafting, and a significant positive correlation between smoking and bone union duration was confirmed in free vascularized bone grafting.
Conclusion
It is necessary to have caution for nonunion when considering pedicled vascularized bone graft in smoking patients with scaphoid nonunion.

Keyword

Scaphoid nonunion; Vascularized; Bone graft; Smoking; Meta-analysis

Figure

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  Fig. 1. (A) Thirty-one studies were finally enrolled following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. (B) The risk of bias was assessed by RoBANS (Risk of Bias Assessment tool for Non-randomized Study). Enrolled studies were measured unclear risk of bias in the measurement of exposure and confounding variables.

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  Fig. 2. (A) The union rate of vascularized bone graft in 908 patients (31 studies for scaphoid nonunion) was announced from 27.3% to 100%. Average of the union rate was analyzed as 82.1% (95% confidence interval [CI], 0.77–0.86). (B) The funnel plot showed asymmetry which suggests the existence of publication bias.

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  Fig. 3. The correlation of age and the union rate showed a negative correlation (correlation coefficient [r]=–0.0151 95% confidence interval, –0.0294 to –0.0008) in that union rate decreased with older age.

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  Fig. 4. (A) In the subgroup analysis of free vascularized bone graft, the correlation of smoking rate and the bone union period showed a positive correlation (correlation coefficient, 0.8581; 95% confidence interval [CI], 0.4561–1.2601). (B) The average union rate was analyzed as 87.3% (95% CI, 0.80–0.92) in the free vascularized bone graft group.

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  Fig. 5. (A) The correlation of smoking rate and the union rate showed a negative correlation (correlation coefficient [r]=–0.0028; 95% confidence interval, -0.0055 to -0.0001) in the subgroup analysis of pedicled vascularized bone graft. (B) The average union rate was analyzed as 79.6% (95% CI, 0.73-0.85) in the pedicled vascularized bone graft group.

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