Obesity, smoking did not negatively impact surgical treatment of distal radius fractures
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Patients who were obese or smokers who underwent surgical treatment for distal radius fractures experienced excellent radiographic and functional outcomes postoperatively at 1 year, according to published results.
However, fewer smokers had healed fractures at 3 months postoperatively and investigators said lifestyle interventions that focus on weight loss and smoking cessation should be emphasized when possible.
Tamara D. Rozental , MD, and colleagues categorized 200 patients who underwent surgical treatment for distal radius fractures between 2006 to 2017 into obese and nonobese groups based on WHO BMI classification, as well as current, former and never smokers based on reported cigarette use. Researchers considered patient-reported outcome measures, range of motion arc, radiographic union and change in radiographic alignment between first and last follow-up as primary outcome measures. Researchers also used multivariable models to correct for age, sex, comorbidities, fracture complexity, osteoporosis and time to surgery.
Overall, researchers identified 39 patients with a BMI of 30 kg/m2 or greater and 161 patients with a BMI of less than 30 kg/m2. In addition, there were 148 never smokers, 32 former smokers and 20 current smokers. Results showed patients who were obese had more comorbidities; however, the obese and nonobese groups had similar fracture types. Researchers found acceptable QuickDASH scores close to those of the general population at 3-month and 1-year follow-up in the obese and nonobese groups. QuickDASH scores were higher in patients who smoked at 3-month follow-up, according to results. Patients who smoked also had a lower percentage of radiographically healed fractures at 3 months, researchers noted. Results showed similar motion, radiographic union scoring system score and alignment among the obese and nonobese groups. Although patients who smoked had small differences in patient-reported outcomes at final follow-up, researchers found similar range of motion, fracture healing and complication rates among smokers, former smokers and never smokers.
“The orthopedic literature has found that obese patients and smokers tend to have worse outcomes and more complications than their counterparts. Our results show that treatment for distal radius fractures in obese and smoking patients is safe, and these patients may be treated like the general population with similar long-term results. Their short-term outcomes, however, demonstrate higher disability and, in the case of smokers, slower fracture healing,” Rozental, chief of hand and upper extremity surgery at Beth Israel Deaconess Medical Center, told Healio.com/Orthopedics. “Obesity and smoking are currently considered among the two most important preventable causes of poor health in developed nations, and both are modifiable risk factors. As such, we believe that lifestyle interventions focusing on weight loss and smoking cessation should be emphasized whenever possible.” – by Casey Tingle
Disclosure: Rozental reports no relevant financial disclosures.
Perspective
Back to TopNeal C. Chen, MD
In an era where elective surgery in patients who are obese or smoke is discouraged, the article by Matthew J. Hall, MD, and colleagues on the effect of obesity and smoking on outcomes after volar plate fixation of distal radius fractures is reassuring. Although not elective surgery, the decision to operate on distal radius fractures involves some discretion depending on the fracture severity. Readers can take some reassurance that differences in healing and complication rates among obese patients or smokers are not large.
However, reassurance does not obviate the need for discretion. In their study, patients who were obese had a greater number of co-morbidities. In a sick patient with multiple co-existent illnesses and borderline indications for operative distal radius fixation, this data does not give license to operate indiscriminately.
In general, Hall and colleagues give us a reasonable picture that obese patients and patients who smoke may be approached in a similar fashion to others who sustain a distal radius fracture, and decision making regarding these injuries should not be disproportionately affected by these factors.
Program director, Hand Surgery Fellowship Program
Boston
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