by Woods M

A fractured bone can take several weeks—or even months to heal, depending on the bone and the severity of the injury. Sometimes a bone has difficulty healing properly. This is called a nonunion of the bone. It can extend healing time and lead to further complications. Nonunions can occur for a variety of reasons, including lifestyle choices.

Researchers from Washington and Philadelphia wanted to examine the effects of smoking on bone healing after a fracture. The study, published in the Journal of Bone and Joint Surgery, found that smoking significantly increases the healing time of fractures.

About the Study

The systematic review included 19 observational studies that looked for any potential relationship between smoking and healing rate of fractures. The review included a total of 6,356 adults with 6,374 fractures.

The review found that compared to non smokers, smokers were:

  • Twice as likely to have a nonunion of tibia (lower leg bone)
  • Twice as likely to have a nonunion of any long bone (bones of arms or legs)
  • Nearly twice as likely to have a nonunion of open fractures

Smokers had longer healing time than nonsmokers by about 6 weeks, but the difference was not statistically significant.

How Does this Affect You?

A systematic review is considered a reliable form of research because it combines several smaller studies. The higher the number of participants the more reliable the results may be. Although, the review is only as reliable as the studies that were included. In this case, the included trials were observational studies. Because of their design, observational studies cannot establish cause and effect but simply find possible relationships. However, smoking has been linked to delayed healing in previous trials and reviews. It is also well established that smoking can impair blood flow and poor blood flow can slow healing, so a connection between smoking and nonunion of fractures is a reasonable one.

If you are a smoker, consider quitting or at least reducing the amount you smoke if you have a fracture. Smoking has an immediate effect on blood flow so quitting while you have the fracture may be beneficial. Talk to your doctor about tools that are available to help you to quit such as patches, nicotine gym, or medications. The quitting process may be difficult, but it will result in quicker healing times and perhaps that will give you the last push to quit.


American Academy of Orthopaedic Surgeons 

American College of Foot and Ankle Surgeons 


Scolaro JA, Schenker ML, et al. Cigarette smoking increases complications following a fracture: a systematic review. J Bone Joint Surg Am. 2014 Apr 16;96(8):674-681.

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