Session III - Hip / Femur

Fri., 10/11/13 Hip/Femur, PAPER #47, 10:21 am OTA 2013

Morbid Obesity Increases the Risk of Systemic Complications in Patients With Femoral Shaft Fractures

Stuart Deaderick, BS; Robert F. Murphy, MD; John C. Weinlein, MD;
University of Tennessee – Campbell Clinic, Memphis, Tennessee, USA

Purpose: Morbid obesity (body mass index [BMI] ≥40) is being encountered with increasing frequency in orthopaedic trauma patients. We sought to investigate the impact of obesity on morbidity and mortality in patients that underwent reamed intramedullary nailing of closed femoral shaft fractures.

Methods: All patients with a closed femoral shaft fracture that were treated with reamed intramedullary nailing over a 5-year period were queried. Clinical data collected included height, weight, BMI, ISS, GCS (Glasgow Coma Scale), Chest AIS (abbreviated injury scale), time to definitive fixation, hospital days, ICU days, ventilator days, and complications (acute respiratory distress syndrome [ARDS], sepsis, pneumonia, pulmonary embolism, and death). Normal weight patients (BMI <25) were compared to morbidly obese patients (BMI ≥40). Odds ratios (ORs) were used to compare risk of complications. BMI was also analyzed as a continuous variable.

Results: 507 patients were treated; 184 (36%) were of normal weight (BMI <25) and 39 (8%) were morbidly obese (BMI ≥40). Patients with morbid obesity were more likely to be older (39.6 vs 29.3 years, P <0.0001) and female (49% vs 27%). Systemic complications occurred in 9 (23.1%) of morbidly obese and 16 (8.7%) of normal weight patients (OR 3.15, P = 0.013). When evaluating individual systemic complications between normal weight and morbidly obese patients, the presence of morbid obesity resulted in an increased risk of ARDS (OR 35.38, P = 0.019) and sepsis (OR 6.49, P = 0.0015). There was a trend for increased risk of pulmonary embolism in morbidly obese patients compared to normal weight patients (OR 5.028, P = 0.0536). Overall, morbidly obese patients with a femur fracture had a mortality rate of 10.2%. Morbidly obese polytraumatized patients (ISS >17) with a femur fracture had a mortality rate of 20%. When comparing mortality between normal weight and morbidly obese patients, the presence of morbid obesity resulted in a significantly increased risk of mortality (OR 46.77, P = 0.01). BMI, analyzed as a continuous variable, was found to be an independent predictor of ARDS, sepsis, and death.

Conclusion: Morbid obesity conveys a significantly increased risk for systemic complications in patients with closed femoral shaft fractures. Patients and patient families need to need to be counseled regarding the high risk of morbidity and mortality. More research is required to determine which physiologic factors in morbidly obese patients make them more susceptible to complications following intramedullary nailing of femoral shaft fractures.

Alphabetical Disclosure Listing

• 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. Δ OTA Grant.