• Hans Nåsell, Carin Ottosson, Hans Törnqvist, Johannes Lindé, and Sari Ponzer.
• Section of Orthopaedics, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. hans.nasell@sodersjukhuset.se
• J Orthop Trauma. 2011 Dec 1;25(12):748-55.

ObjectivesThis study on patients with operatively treated ankle fractures aimed to investigate the impact of smoking on postoperative complications and especially deep wound infections.DesignCohort study with prospective follow-up.SettingUniversity-associated teaching hospital with advanced trauma care.PatientsA consecutive series of patients (n = 906) operatively treated for an acute ankle fracture during a 3-year period was identified. For the analysis, the patients were categorized as nonsmokers (n = 721) and smokers (n = 185). Data were collected from the department database and completed with a review of the patients' medical charts.Main Outcome MeasuresPostoperative complications.ResultsFollow-up data at 6 weeks were available for 98.2% of the patients. Postoperative complications of any kind (30.1% versus 20.3%, P = 0.005) as well as deep wound infections (4.9% versus 0.8%, P < 0.001) were more common among smokers than nonsmokers. Multivariable analyses showed that smokers had six times higher odds of developing a deep infection compared with nonsmokers. A more complicated fracture, associated diabetes mellitus, and unsatisfactory operative fracture reduction also enhanced the risk of postoperative complications.ConclusionsWe conclude that cigarette smoking increases the risk of postoperative complications in patients operatively treated for an ankle fracture. Smoking is a considerable risk factor. Therefore, physicians, nurses, and other healthcare professionals should strive to support patients to stop smoking while still under acute treatment.

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