NCLEX Practice Test

The most significant factor that hinders the fracture healing process is smoking. Smoking is known to impair circulation and reduce the availability of essential nutrients and oxygen that are crucial for bone repair. It decreases the activity of osteoblasts, which are the cells responsible for new bone formation, and also interferes with the overall healing process by promoting complications such as infection and delayed union of the fracture. While a family history of osteoporosis may suggest a predisposition to weaker bones, it is not an immediate factor that directly affects fracture healing in the same way smoking does. High BMI can complicate surgery and increase stress on bones, but it doesn’t inherently impede the healing process like smoking does. Peripheral arterial disease is also significant as it can limit blood flow to the fracture site, but smoking has a more profound negative effect on healing dynamics. In essence, smoking poses a direct risk to the effectiveness of the body's healing mechanisms following a fracture.