The Orthopedic Effects of Electronic Cigarettes: a Systematic Review and Pediatric Case Series.

Introduction:
This text is a systematic review of the literature on the orthopedic effects of electronic cigarettes (ECs) on the musculoskeletal system. The review highlights the scarcity of evidence on the topic and the need for further research. The authors conducted a PRISMa-compliant systematic review of the PubMed, EMBaSE, and Cochrane databases, as well as the OpenGrey database, to identify relevant studies.

Key Points:

* The review found no Level 1 studies and no human clinical studies on the effects of ECs on bone healing or orthopedic outcomes.
* Six experimental studies were found, which clustered around three subtopics: basic science, musculoskeletal health, and wound healing.
* Pywell et al. (2018) found that nicotine consumption in ECs causes vasoconstriction in hand microcirculation.
* Romagna et al. (2013) found that liquified smoke from ECs is significantly more cytotoxic to fibroblast cell cultures than combustible cigarette smoke.
* Kennedy et al. (2019) found that rats exposed to EC vapor had significantly lower load-to-failure in achilles tendon transection and repair compared to rats exposed to cigarettes and control cohorts.
* Reumann et al. (2020) found that mice exposed to cigarette smoke had significantly decreased bone density and bending strength compared to EC vapor and control groups.
* Rau et al. (2019) and Troiano et al. (2019) found that low-dose and high-dose EC vapor exposure in rats resulted in decreased flap survival five weeks after surgery.

Main Message:
The main message of this systematic review is that there is a scarcity of evidence on the orthopedic effects of ECs on the musculoskeletal system. The authors call for high-quality investigation into the topic, as vaping is highly prevalent, especially among adolescents, and its orthopedic effects are poorly understood. The review highlights the need for further research to draw any clinically relevant conclusions about the orthopedic effects of electronic cigarettes.

armstrong ML, Smith N, Tracey R, Jackman h. The Orthopedic Effects of Electronic Cigarettes: a Systematic Review and Pediatric Case Series. Children (Basel, Switzerland). 2022;9(1). doi:10.3390/children9010062