Dear Editor,

We would like to thank Assoc. Prof. Metin Uzun for his letter to the editor regarding our study entitled ‘Augmented compression in exchange nailing for femoral and tibia non-unions accelerates time to radiographic union’ [1].

We note that the mean age between the two groups was found to be statistically significantly different as per table 1 in our study. The noted difference between the ages was not intentional and likely due to the small sample size and retrospective nature of the study. The study was a retrospective analysis of a single surgeon series, and there was always the risk that this would introduce a confounding variable. We had detailed the difference in age in the study, and this was identified as a limitation. However, we also would like to reiterate that the two groups were matched from a mechanical and intervention point of view—only direct exchanges without changes in alignment or alternative fixation strategies were included. Furthermore, age is not specifically an independent factor for poorer bone healing, at least not until the extremes of age [2]. The mean ages of the two groups would not be considered to be at the extreme of age.

This study was intended as a proof of concept, and a large prospective study with the ability to control for confounding variables would be required to support the hypothesis and preliminary findings.

Again we thank the reader for his comments, and hopefully, this response clarifies some of his concerns.


Yours sincerely,

The Authors.