Comment on Hernigou and Schuind: Smoking as a predictor of negative outcome in diaphyseal fracture healing

摘要

We read the study reporting smoking as a predictor of negative outcome in diaphyseal fracture healing [1]. In previous reports, the common causes of nonunion are infection, obesity, smoking, distraction at fracture site, unstable fixation, wrong choice of implant, iatrogenic devitalisation of soft tissues, extent of bone loss and osteoporosis [2, 3]. The information including "diabetes mellitus, tobacco abuse, multiple trauma/polytrauma, associated skin injury (open fracture), presence or absence of head injury, and type of osteosynthesis" was extracted from the medical record by the authors. There is no mention about whether the patient had an infection. An infection can significantly increase the risk of nonunion in diaphyseal fracture healing [2, 3]. It may have an impact on the results and conclusions if a wound infection as risk factor for diaphyseal fracture healing was ignored in the study.