{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:18:25Z","timestamp":1785403105781,"version":"3.56.0"},"reference-count":41,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Smoking is a known risk factor for complications after open tibia fractures, but it is unclear if smokeless tobacco confers a similar risk.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The purpose of this study was to evaluate the rates of postoperative complications after surgical fixation of open tibia fractures in smokeless tobacco users as compared to matched tobacco na\u00efve controls.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted using the national PearlDiver database. For patients who had a unilateral open tibia fracture, smokeless tobacco users (n=121) and tobacco-na\u00efve controls (n=242) were matched at a 1:2 ratio. Rates of bone complications within 1 year were compared using multivariable logistic regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Compared to controls, the smokeless tobacco user cohort demonstrated significantly higher rates of nonunion (OR: 3.42, 95% CI: 1.05 \u2013 11.12), infection \/ inflammatory reaction of implant (OR: 12.45, 95% CI: 2.67 \u2013 58.93), and osteomyelitis of the leg (OR: 6.15, 95% CI: 1.90 \u2013 19.93) within 1 year of open tibia fracture. Compared to the most recent population figures, smokeless tobacco use was significantly under-reported in both males and females.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Smokeless tobacco use confers an increased risk of fracture nonunion, infection or inflammatory response to implant, and osteomyelitis of the leg in patients with open tibia fractures. Surgeons should consider this risk when counseling patients and deciding on treatment plans for patients with tibia fractures.<\/jats:p>\n <\/jats:sec>","DOI":"10.52965\/001c.120370","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T11:43:39Z","timestamp":1739360619000},"source":"Crossref","is-referenced-by-count":2,"title":["Smokeless Tobacco Use is Associated with Worse Outcomes Following Open Tibia Fracture"],"prefix":"10.52965","volume":"16","author":[{"given":"Timothy L","family":"Waters","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04vmvtb21","id-type":"ROR","asserted-by":"publisher"}],"name":"Tulane University","department":["Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1591-0011","authenticated-orcid":false,"given":"Julianna E","family":"Winter","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04vmvtb21","id-type":"ROR","asserted-by":"publisher"}],"name":"Tulane University","department":["Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3373-7962","authenticated-orcid":false,"given":"Bela P","family":"Delvadia","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04vmvtb21","id-type":"ROR","asserted-by":"publisher"}],"name":"Tulane University","department":["Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-5668","authenticated-orcid":false,"given":"William F","family":"Sherman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04vmvtb21","id-type":"ROR","asserted-by":"publisher"}],"name":"Tulane University","department":["Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia C","family":"Lee","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05ect4e57","id-type":"ROR","asserted-by":"publisher"}],"name":"Louisiana State University","department":["Orthopaedics"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2024,7,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1206235","DOI":"10.1155\/2018\/1206235","article-title":"The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms","volume":"2018","author":"A. 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