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Obesity increases complication risk of ORIF for acetabular fractures

Patients with a body mass index of 30 or more were 2.6 times more likely to develop a deep venous thrombosis.

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Obesity significantly increases the risk of suffering several common complications associated with acetabular fracture surgery, a new study shows.

Madhav A. Karunakar, MD, and colleagues at the University of Michigan Hospital in Ann Arbor, retrospectively reviewed complication rates for a consecutive series of displaced acetabular fracture patients treated with ORIF between July 1999 and June 2003.

Their study included 169 patients — 126 men and 43 women — with an average age of 41 years. These patients had an average body mass index (BMI) of 30 (range 17 to 60) and a median BMI of 29. Fifty-nine patients had elementary fractures and 110 had associated fractures, according to the study.

All ORIF procedures were performed by one of three fellowship-trained orthopedic trauma surgeons. They used an ilioinguinal approach for 49 cases, a Kocher-Langenbeck approach for 118 cases and a combined ilioinguinal Kocher-Langenbeck approach for two cases, according to the study.

For the data analysis, the researchers divided patients into four groups based on BMI as follows:

1. normal group: 47 patients with a BMI of less than 25;
2. overweight group: 47 patients with a BMI from 25 to 29;
3. obese group: 55 patients with a BMI from 30 to 39; and
4. morbidly obese group: 20 patients with a BMI of 40 or higher.

All patients had at least one month postoperative follow-up, the authors noted.

Overall, the researchers identified six deep infection cases and two superficial infection cases, none of which developed in patients with either a normal or overweight BMI. Postoperative infections developed in five obese patients (9.1%) and three morbidly obese patients (15%), according to the study.

Measuring BMI as a continuous variable, the researchers found that BMI significantly correlated with the following:

1. estimated blood loss (P=.003);
2. prevalence of wound infection (P=.002); and
3. prevalence of deep venous thrombosis (P=.03).

Compared to normal patients, obese patients demonstrated a 2.1 times greater risk for losing an estimated 750 ml of blood or more and 2.6 times greater risk for developing deep venous thrombosis. Morbidly obese patients had a five times higher risk of developing wound infections, according to the study.

However, the researchers found no relationship between BMI and rates of heterotopic ossification, nerve palsy or pulmonary embolism, the authors noted.

The study was published in the Journal of Bone and Joint Surgery.

For more information:

• Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am. 2005;87-A:1498-1502.