The impact of BMI on morbidity and mortality after femoral fractures

Abstract

Purpose Femur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes to complications after femoral fractures. Methods Using the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 41,362 patients into groups based on their BMI: Normal Weight (NW), Overweight (OW), Obese (OB), Severely Obese (SO), and Morbidly Obese (MO). We compared each BMI group to the NW cohort for differences in demographic factors, comorbidities, complications, and mechanism of injury. Results OB, SO, and MO patients sustained higher rates of traumatic injury from high energy mechanisms, such as motor vehicle trauma, in comparison to NW patients, who sustained more injuries from falls ( p < 0.05). Correspondingly, obese patients were more likely than NW patients to sustain shaft and distal end fractures ( p < 0.05). At hospital admission, obese patients presented with more comorbidities, such as bleeding disorders, congestive heart failure, diabetes mellitus, and hypertension ( p < 0.05). Despite these individual findings, patients with OB, SO, and MO BMI, as opposed to NW BMI, were independently associated with a higher probability of developing at least one post-trauma complication. More specifically, MO patients were associated with a 45% higher odds of developing a complication ( p < 0.05). Conclusion Irrespective of presenting with more comorbidities and sustaining high energy injuries, OB, SO, and MO patients were independently associated with having a higher risk of developing complications following a femoral fracture. Overall, better clinical outcomes are observed among patients with no underlying conditions and normal BMI.

Obesity and bone health: key 2020–2022 highlights and implications

“…However, patients with an excess body mass appeared to be at a higher risk of developing complications following a femoral fracture along with poorer clinical outcomes than those with a healthy body mass. 29 Some of these observations may stem from what is measured as well as how, plus observations that dynapenic abdominal obesity, denoting weak muscles, is related to a heightened risk for falling among older adults, 30 as is obesity assessed by body mass index and waist circumference in older Chinese cases who might sustain falls. 31 Importantly, if a fracture injury occurs, the presence of obesity tends to hamper repair 32 and may disrupt bone morphology via inflammatory and other mechanisms 33,34 as identified in a laboratory study by Stephen et al, 35 and may be especially accentuated in those categorized as being morbidly obese.…”

Patient-reported Anxiety Scores Are Associated With Lower Physical Function in Patients Experiencing Orthopaedic Trauma

“…These associations refer to absolute final, not recovered, self-reported function. Intuitively, weight, comorbidities, and age negatively impact a patient’s function, and this has been corroborated across a variety of disciplines and populations [1, 10, 15, 23]. More importantly, anxiety remains independently associated with lower physical function when accounting for these other associated variables.…”

Biomechanical and Finite-Element Analysis of Femoral Pin-Site Fractures Following Navigation-Assisted Total Knee Arthroplasty

“…When designing the workflow, the diameter and number of drill holes should be minimized, as should the volume of anchors. Patient factors predisposing to femoral fracture may include obesity 31 , primary osteoporosis 32 , diabetes 33 , and malignancies 34 . Obesity results in greater weight-bearing, and osteoporosis implies reduced biomechanical strength of the femur.…”