Session VII - Pelvis

Fri., 10/6/06 Pelvis, Paper #41, 3:54 pm

Morbid Obesity: Is Operative Treatment of Displaced Acetabular Fractures Worth the Risk?

George Russell, MD (d-Zimmer); Robert Dews, MD (n);
Matthew Graves, MD (n); Scott Porter, MD (n); Zhen Qin, MS (n);
Department of Orthopedics, University of Mississippi Medical Center, Jackson, Mississippi, USA

Purpose: Displaced acetabular fractures require operative intervention for optimal results. Obesity and morbid obesity is becoming more prevalent. Morbid obesity is defined as a body mass index (BMI) 40. The purpose of this investigation is to evaluate the early results of operative treatment of acetabular fractures in morbidly obese patients.

Methods: A prospectively gathered database demonstrated 349 patients who underwent open reduction and internal fixation for acetabular fractures over a 60-month period. Of those patients, 39 were morbidly obese. Patient weights were self-reported. There were 15 posterior wall (OTA 62-A1), 10 transverse/posterior wall (OTA 62-B1), 5 T-type (OTA 62-B2), 3 transverse (OTA 62-B1), 3 anterior column/posterior hemitransverse (OTA 62-B3), 1 anterior column (OTA 62-A3), 1 posterior column/posterior wall (OTA 62-A2), and 1 both-column (OTA 62-C3) fractures. Early results of morbidly obese patients (group 1) were reviewed. Perioperative complications were compared to patients with BMI <40 (group 2). Factors evaluated were: estimated blood loss, operative time, length of hospital stay, and overall complication rate (as defined by wound complications or heterotopic ossification requiring subsequent surgery, failure of fixation, nerve palsy, death).

Results: Follow-up ranged from 6 to 48 months. Fracture reductions were perfect in 23, imperfect in 10, and poor in 6. Fixation failure was noted in 9 patients and typically associated with comminuted posterior wall fractures. Eight patients developed deep infections necessitating debridements. Nine patients required secondary surgery for wound healing problems. Of those, 6 required one additional surgery, three required 2, two required 3, one required 5, and one required 12 additional surgeries. Six patients proceeded to total hip arthroplasty and two of those required revisions.

The average estimated blood loss was 903 cc in group 1 versus 630 cc in group 2 (P <0.044). Operative time averaged 293 minutes in group 1 versus 250 in group 2 (P <0.008). Hospital stay for group 1 averaged 26 days versus 15 days in group 2 (P <0.008). Complication rate for group 1 was 67% versus 16% in group 2.

Conclusion/Significance: These data show that there is a significant increase in estimated blood loss, operative time, and length of hospital stay. Moreover, the risk of complications should be heavily weighed prior to operative intervention.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.