LAUSR

We read with great interest the article entitled “The Influence of Preoperative Central Sensitization on the Postoperative Prognosis of Pilon Fractures: A Retrospective Study” published in your esteemed journal. 1 The study focuses on the impact of preoperative central sensitization (CS) on postoperative pain, functional recovery, and psychological status in patients with Pilon fractures. Through retrospective analysis, it clearly identifies the phenomenon that patients with preoperative CS experience poorer postoperative recovery, providing a significant basis for individualized clinical intervention. However, we wish to raise several overlooked issues for further discussion with the authors, which may affect the interpretation and application of the results. In the grouping methodology, the study categorized patients based solely on preoperative CS status without incorporating fracture severity as a factor. This approach risks misattributing the prognostic influence of the fracture itself to CS, thereby introducing potential confounding bias. The OTA/AO 43 classification for Pilon fractures stratifies severity based on key indicators such as comminution and articular surface involvement—factors independently established to influence post-operative functional recovery and pain relief. 2 Research by Jansen et al explicitly demonstrates a significant correlation between fracture severity according to the AO classification and both AOFAS and VAS scores. 3 We recommend supplementary stratified analysis by fracture type or multivariate regression adjustments to verify the independent effect of CS on outcomes. The absence of detailed postoperative analgesia protocols and the lack of analysis regarding the interaction between analgesia and CS may undermine the reliability of the conclusions. The manuscript mentions “standardized postoperative medication and treatment protocols” but does not specify the application of multimodal analgesia, the rationale for drug dosage adjustments, or individualized strategies for CS patients. Given that CS significantly heightens pain sensitivity, a