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. 2025 Oct 15;17(10):e94649.
doi: 10.7759/cureus.94649. eCollection 2025 Oct.

Impact of Smoking as a Risk Factor for Surgical Site Infections After Open Reduction and Internal Fixation (ORIF) of Distal Radius Fractures

Tariq Ahmad  1 , Muhammad Arsalan Azmat Swati  2 , Kamran Khan  1 , Khalid Khan  3 , Rahim Khan  2 , Ziyad Ahmad  2 , Shakir Ullah  4 , Atizaz Ali Jan  5   6
Affiliations

Impact of Smoking as a Risk Factor for Surgical Site Infections After Open Reduction and Internal Fixation (ORIF) of Distal Radius Fractures

Tariq Ahmad et al. Cureus. .

Abstract

Background: Smoking is a recognized risk factor for postoperative infections, but its specific impact on infection rates following distal radius fracture fixation remains underexplored.

Objective: To compare the postoperative infection rates following open reduction and internal fixation (ORIF) of distal radius fractures in smokers versus non-smokers.

Methodology: This retrospective cohort study was conducted at the Mardan Medical Complex, Mardan, Pakistan, over a three-year period (August 2020-July 2023). A total of 640 patients aged ≥18 years who underwent ORIF for distal radius fractures and had documented smoking status and 1-year postoperative follow-up were included. Patients were divided into smokers (n = 310) and non-smokers (n = 330). Data on demographics, comorbidities, surgical details, and microbiologically confirmed postoperative infections were analyzed. Chi-square test and multivariate logistic regression were used for statistical analysis in the IBM SPSS Statistics version 26.

Results: Infection rates were significantly higher among smokers (39 patients; 12.58%) compared to non-smokers (10 patients; 3.03%) (p < 0.001). Early infections (<30 days) occurred in 20 smokers (6.45%) and six non-smokers (1.82%), while late infections (≥30 days) were reported in 19 smokers (6.13%) and 4 non-smokers (1.21%). Multivariate logistic regression confirmed smoking as an independent predictor of postoperative infection, with smokers having more than a threefold increased risk compared to non-smokers (adjusted OR = 3.52, 95% CI: 1.68-7.37, p < 0.001). Poor glycemic control (HbA1c ≥7) also doubled the risk of infection (adjusted OR = 2.14, 95% CI: 1.01-4.55, p = 0.046). Additionally, prolonged operative time (>90 minutes) was associated with approximately a twofold increased risk (adjusted OR = 2.02, 95% CI: 1.03-3.97, p = 0.040).

Conclusion: Smoking significantly increases the risk of postoperative infections following ORIF of distal radius fractures.

Keywords: distal radius fracture; orif; postoperative infection; risk factors; smoking.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Medical Teaching Institution Bacha Khan Medical College Mardan issued approval 321/ORT/BKMC. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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