Opportunistic Use of Computed Tomography to Determine Muscle-Adipose Ratio Reliably Predicts Wound Complications after Kocher-Langenbeck Surgical Exposure of the Acetabulum.

Abstract

To determine whether muscle-to-adipose ratio (MAR) along the course of a Kocher-Langenbeck (KL) incision is more accurate at predicting post-operative wound complications following acetabuluar fixation than waist-hip ratio (WHR) or body mass index (BMI). Retrospective case series. Level-1 Trauma Center.Patients/Participants: Patients who sustained an acetabular fracture and had fixation through a KL approach. The calculation of the MAR. Presence of a surgical site infection or a wound healing complication. 193 patients were included in the study and mean follow-up was 17.4 months. Thirty (15.5%) patients developed a wound complication. Seventeen (8.8%) patients developed a superficial infection and thirteen (6.7%) developed a deep infection. Mean BMI for those who developed a wound complication was 35.9. The mean MAR was 0.67 for patients who developed a wound complication versus 0.75 for those who did not. ROC analysis showed an area under curve (AUC) for BMI to be .717 (95% CI, .577-.857, p = .006) and for MAR to be .680 (inverted, 95% CI .507-.854, p = .022). The AUC for WHR was not statistically significant. MAR is a significant predictor of post-operative wound complication in obese patients undergoing treatment of posterior wall acetabular fractures. The higher rate of wound complications in patients with a low MAR should be considered in the treatment of these patients and may be used to guide discussion regarding the risks of surgery, as well as the potential use of adjuncts to reduce wound healing complications. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.