Complications Of Fractures Research Articles

Analysis of Surgical Complications in Mandibular Fractures in the Center of Italy: A Retrospective Study.

Mandibular fractures are the second most common maxillofacial fractures. The prevalent treatment for this kind of fractures is either a surgical procedure such as maxillomandibular fixation or open reduction and internal fixation or a combination of both. Sometimes the patients might develop locoregional postoperative complications. The most frequently reported complications are trigeminal V3 injury and surgical site infection. A 4-year retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Policlinico Umberto I of Rome, Italy, and the postoperative complications after mandibular fracture surgical treatment were collected. The authors studied the characteristics of each complication and the correlation with the type of mandibular fracture and the surgical treatment chosen.

Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study

BackgroundPatellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management.MethodsIn a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines.ResultsA total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%).ConclusionSurgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications.Trial registrationTrial registration number (DRKS):00027894.

Frequency of Diplopia in Zygomatic Complex Fractures-A Cross-Sectional Descriptive Study.

The zygomatic complex is the second most common fracture of the facial bones after the nasal bone. The prominent convex shape of the zygoma makes it vulnerable to traumatic injury. Diplopia is one of the serious complications of zygomatic complex fracture and is a common subjective complaint. To determine the frequency of diplopia in zygomatic complex fractures. Methodology. A cross-sectional descriptive study was conducted at the Oral and Maxillofacial Surgery Ward, Civil Hospital, Karachi, Pakistan. The duration of the study was 1 year (March 1, 2021 to February 28, 2022). A total of 126 patients having zygomatic complex fractures were included in this study. After recording the patient's complete history, like demographic details and cause for fracture, diplopia was examined clinically. If, during the examination, the patient complained of double vision, this was labeled as diplopia positive (Yes) and negative (No) if the patient did not have any such complain. Data were statistically analyzed. The mean (±SD) age of patients was 33.42 (±9.27), with 91 (72.2%) male patients and 35 (27.8%) female patients. The frequency of diplopia in zygomatic complex fractures was observed in 52 (41.3%) patients. The rate of diplopia was significantly high in patients aged between 31 and 40 years (P-value=0.0005). The frequency of diplopia among patients having zygomatic complex fractures was high in this study. Thus, forming a strategy to properly diagnose and treat it and to prevent persistent morbidity to improve patient's quality of life is recommended.

PREVALENCE OF OSTEOPOROSIS IN HIV-INFECTED PATIENTS INITIATING ANTI-RETROVIRAL DRUGS LIVING IN JOHANNESBURG

Low-energy fractures complications are a major public health issue that make osteoporosis even worse. In sub-Saharan Africa, the prevalence of osteoporosis varies from 18.2% to 65.8%. There was no change in bone mineral density between HIV-infected and non-HIV-infected women in Sub-Saharan Africa, where HIV is widespread. Other investigations that demonstrated that HIV-infected people had poor BMD both before and after starting anti-retroviral treatment did not consistently show a low BMD finding. Inflammation-mediated bone remodelling has been associated with low BMD in HIV-infected patients. Antiretroviral Therapy has been demonstrated to exacerbate bone loss in addition to the pre-existing intrinsic risk of developing osteoporosis.Question: Is there loss of bone in HIV-infected patients before initiating ART?The patients who were HIV-positive and enrolled in the ADVANCE research were retrospectively reviewed on a desk. All of the 1053 individuals in the ADVANCE research had a DXA scan performed to evaluate BMD as part of the initial screening and recruitment approach. The ADVANCE research enrolled HIV-positive people and randomly assigned them to three ART arms.A total of 400 patients were reviewed. Of these 400 records reviewed, 62.3% were female. 80% of the participants were younger than 40 years old, and 3% were older than 50 years. 82% were virally suppressed with less than 50 viral copies. The prevalence of osteopenia was 25.5% and osteoporosis was 2.8%, observed in predominantly African female participants aged between 30 and 39 years.The findings of this study confirm that there is pre-existing bone loss among HIV-infected ART naïve individuals. Approximately 28.3% in our study had clinically confirmed evidence of bone loss and of these, 2.8% of the entire cohort had osteoporosis. Bone loss was most prevalent in black females who are virologically suppressed.

Syndesmosis Injuries in Lateral Malleolar Fractures Accompanied by a Posterior Malleolar Fracture: A Nonfixed Posterior Fracture Fragment May Not Affect Postoperative Tibiofibular Joint Malreduction Rates.

The fact that lateral malleolar fracture is accompanied by posterior malleolar fracture may adversely affect syndesmosis malreduction rates. We aimed to compare syndesmosis malreduction rates determined on postoperative radiographs between isolated lateral malleolar fractures and lateral malleolar fractures accompanied by posterior malleolar fractures. We retrospectively examined 128 operative patients: 73 with isolated lateral malleolar fractures (group L) and 55 with lateral + posterior malleolar fractures (group LP). In group LP, no patients received posterior fragment fixation. In both groups, indirect syndesmosis fixation was performed with a single screw after open reduction and internal fixation of the lateral malleolus. Patient age, sex, fracture side, fracture type (Lauge-Hansen and Danis-Weber classifications), Kellgren-Lawrence osteoarthritis classification, syndesmotic incongruency on postoperative radiographs, syndesmotic malreduction of postoperative fibula fracture, fracture union time, complication rates, accompanying injuries, and preoperative and postoperative radiographic syndesmotic measurements (tibiofibular overlap, tibiofibular clear space, medial clear space) were recorded, and the groups were compared. Mean ± SD age was 44.32 ± 15.66 years in group L and 48.93 ± 14.03 years in group LP (P = .087). There were no significant differences in preoperative and postoperative tibiofibular distance, tibiofibular overlap, and medial clear space values between groups (P > .05). The prevalence of grade 2 fractures according to the Kellgren-Lawrence classification was significantly higher in group LP (P = .047). Postoperative syndesmosis malreduction was detected in 12 patients in group L and in nine in group LP (P = .991). In lateral malleolar fractures accompanied by small-fragment posterolateral or avulsion-type posterior malleolar fractures, closed syndesmotic screw fixation does not cause syndesmosis malreduction.

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

Fragment reattachment in situ for complicated crown-root fracture in children permanent anterior: a case report

Outcome of Plate and Screw Fixation in Femoral Shaft Fracture at Sanjiwani General Hospital Gianyar in 2021

Background: Femoral shaft fracture that reported the one year mortality rate post trauma is still high around 10-20%and it is a challenged in orthopedics. Surgical therapy in the orthopedic field has been highly developed in the treatment of femoral shaft fractures. Gold standard therapies that have been used for femoral shaft fractures is intramedullary nail but the ORIF PS method is still often used especially in hospitals that have inadequate health facilities by considering several risk factors and complications that can occur during the perioperative.&#x0D; Methods: This study is a retrosepctive descriptive study that aims to indentify the outcome of plate and screw fixation in femoral shaft fracture at Sanjiwani General Hospital Gianyar in 2021. Medical record, surgical procedure, and outpatient control reports were reviewed to colect pre-, intra-, and postoperative details by identifying data on complications that occur in patients with open and closed femoral shaft fractures who had performed ORIF PS at Sanjiwani General Hospital in January 2021 - December 2021. &#x0D; Result: Major complication were represented by perioperative bleeding (33%), redisual pain (8%), no complication of implant failure, deep infection, minor infection such as superficial infection and impaired wound healing in this study.&#x0D; Conclusion: In this study was concluded that the most common femoral shaft fracture complication that performed ORIF PS is perioperative bleeding pain and other complications are very rare due to several factors&#x0D; Keywords: Open reduction internal fixation; Femoral shaft fracture; Complication; Human and medicine

Unveiling Peripherally Inserted Central Catheter Fractures and Related Complications in the Neonatal Intensive Care Unit: A Concise Review.

Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal complication. This narrative review aims to identify factors predisposing neonates to PICC fracture and related complications, such as catheter jamming, and explore strategies for preventing and detecting this complication. A thorough search of PubMed and Google Scholar was conducted using relevant keywords to identify articles discussing PICC fracture in neonates. The review encompassed English-language literature on PICC fracture in neonates, with additional pertinent publications identified through citation searching. The incidence of PICC fracture in neonates varies from less than 1% to 10%, with a higher risk associated with prolonged catheterization, lower gestational age and lower birth weight, and the use of multi-lumen catheters. PICC fractures can occur during insertion, maintenance, or removal. Factors such as catheter duration, gestational age, birth weight, and catheter type increase the risk of PICC fracture. Excessive syringe pressure, securement failure, and excessive force during removal are contributing factors. Catheter fatigue and thin-walled catheter design are common causes of breakage. Preventive measures include proper training of healthcare providers, regular monitoring, early recognition, and prompt catheter removal upon fracture. Preventing and detecting PICC fractures is crucial for neonatal safety. Vigilance during insertion, maintenance, and removal, along with care to avoid excessive force during removal and high pressure during flushing, can help prevent catheter breakage. More research is required to improve prevention strategies for PICC fractures in neonates.

Provision of specialized medical care to patients in a modern inpatient polyclinic complex

The article is devoted to the analysis of medical and economic standards of medical rehabilitation of patients with complicated and un[1]complicated fractures of the mandible. The structure of therapeutic measures for the treatment of fractures of the mandible in the hospital, complications of fractures of the mandible were studied. The results of the analysis of medical documentation of 550 patients with fractures of the mandible and their complications who sought medical help in Maxillofacial hospital for war veterans, Pirogov City Clinical Hospital №1 for the period from 2006 to 2021 are presented.

Case Report of a Post-Traumatic Orbital Encephalocele in an Adult

Orbital encephalocele is a rare severe and sight-threatening complication of orbital roof fractures that can be challenging to diagnose, we present the case of a 56-year-old man suffering from post-traumatic orbital encephalocele.

A 3D cohesive‐frictional coupled interface model for mesoscale simulation of steel fibre‐reinforced concrete

AbstractA 3D mesoscale finite element modelling approach is developed for simulating complicated damage and fracture behaviour in steel fibre‐reinforced concrete (SFRC) with explicit modelling of fibre–matrix interfaces. In this approach, a new 3D four‐noded cohesive‐frictional coupled interface element is developed to model the nonlinear interfacial bond‐slip behaviour, supplemented by a kinematic multiple‐point‐constraint (kMPC) algorithm to simulate the wrapping effect of the mortar around the fibres. They are implemented as a user‐defined element (UEL) and a user‐defined MPC subroutine in ABAQUS, respectively. Three cohesive‐frictional constitutive relationships are proposed to describe the nonlinear bond‐slip behaviour of different fibre–matrix compositions. The new approach is validated by single fibre pullout tests, direct tensile tests and three‐point bending tests of SFRC specimens with randomly distributed fibres. The results show that the new approach is capable of effectively capturing typical failure mechanisms in SFRC, such as fibre yielding, matrix failure, and fibre–matrix debonding and slipping.

Clinical evaluation of lithium disilicate versus indirect resin composite partial posterior restorations – A 7.8-year retrospective study

ObjectiveTo evaluate retrospectively the longevity of lithium disilicate ceramic (LidiSi) vs. laboratory-processed resin-based composite (RBC) inlay/onlay/overlay restorations and risk factors associated with restoration deficiencies and failures. MethodsPatients (n = 91) receiving LidiSi (73.1%) and RBC (36.9%) inlays/onlays/overlays between 2007 and 2017 were selected. The restorations were evaluated using the modified U.S. Public Health Service criteria. The survival of the restorations was analyzed using the Kaplan-Meier method and log rank test. Factors affecting the occurrence of deficiencies were examined by logistic regression analysis. This was performed with the use of the Generalized Estimating Equation model including Repeated measurements (GEER), with the consideration that the same patient had several teeth in the sample. Risk estimation was conducted for each evaluated criterion (p < 0.05). ResultsThe survival of LidiSi and RBC restorations were 96.8% and 84.9%, respectively after a mean observation period of 7.8 ± 3.3 years. The annual failure rate was 0.2% for LidiSi and 1.0% for RBC. The probability of survival was above 98% for both restorations in the first 6 years, however, it dropped to 60% for RBC by the end of the 15th year. For both materials the reasons for failure included secondary caries, restoration fracture, and endodontic complication. In addition, LidiSi also failed due to tooth fracture, while RBC due to marginal gap formation and loss of retention. Among the evaluated risk factors, material of restoration (OR=6.8, CI95%:3.1–14.9), oral hygiene (OR=8.0, CI95%: 2.9–22.1], and bruxism (OR=1.9, CI95%: 1.1–3.3) showed a significant impact on the evaluated criteria. SignificanceLidiSi and RBC restorations showed similarly excellent 6-year survival, however, in the long term significantly more failures should be expected for RBCs.

Comparison of reconstruction nails versus dual implants in the treatment of ipsilateral femoral neck and shaft fractures in adults: a meta-analysis and systematic review

ObjectiveThere is no consensus on the optimal treatment for ipsilateral femoral neck and shaft fractures. This meta-analysis aims to assess the effectiveness of reconstruction nails and dual implants in treating ipsilateral femoral neck and shaft fractures to provide a basis for decision-making when selecting the optimal approach.MethodsRelevant articles were retrieved from Pubmed, Embase, and Cochrane databases using the keywords "neck of femur", "shaft" and "fracture fixation" from inception until November 17, 2022. The screening process of the studies was conducted independently by two assessors, who assessed each study's eligibility and two assessors assessed the quality. Then compared differences in outcome measures using RevMan 5.3 software.ResultsA total of ten retrospective cohort studies were included. There were no significant differences in union time, union rate, union-related complications (malunion, nonunion, delayed union) of femoral neck and shaft fractures, osteonecrosis of the femoral head, and functional outcomes (Friedman-Wyman scoring system) (P > 0.05).ConclusionOur pooled estimates indicated that reconstruction nails and dual implants for ipsilateral femoral neck and shaft fractures could yield satisfactory surgical results, and that there is no difference between the two treatment methods.Trial registrationThis meta-analysis was registered on the PROSPERO website (registration number: CRD42022379606).

Novel use of an image-guided supraorbital craniotomy via an eyebrow approach for the repair of a delayed traumatic orbital encephalocele: illustrative cases.

Traumatic orbital encephaloceles are rare but severe complications of orbital fractures. These encephaloceles can present months to years after the initial injury. The authors present two cases of traumatic orbital encephalocele in young males struck by motor vehicles. The exact traumatic mechanism of these encephaloceles is unknown, and diagnosis can be confounded by concomitant injuries. The use of a minimally invasive supraorbital keyhole craniotomy has the potential to change how this disease process is managed and has not been previously documented in this setting.

Traumatic Dental Injury to Primary Teeth

Background: Traumatic dental injuries (TDI) in primary teeth can significantly impact the quality of life of affected children, often leading to discomfort and pain. These injuries encompass various diagnostic categories, such as concussion, luxation injuries, uncomplicated crown fractures, complicated crown fractures, and avulsion. Methods: In April 2023, we conducted an extensive electronic literature search across multiple databases, including Web of Science, Scopus, PubMed, Google Scholar, African Journals Online, ResearchGate, and Google, utilizing the Population, Concept, and Context framework. Search terms and keywords were meticulously combined using Boolean operators. The screening of titles and abstracts of publications related to traumatic dental injuries in primary teeth among children was performed independently by three research assistants. Inclusion criteria encompassed original research articles, case reports, and case series related to traumatic dental injuries in primary teeth among children conducted in African countries. Review articles, systematic reviews, viewpoints, books, letters, editorials, book chapters, perspectives, and news pieces on the subject were excluded. Results: Three independent investigators screened the full texts for inclusion criteria, resulting in the exclusion of twenty-six articles that did not meet the predefined criteria. Six articles were included, as they aligned with the aim of this review. All included studies were cross-sectional in nature. Conclusion: Traumatic dental injuries in primary teeth are a noteworthy concern in children. The key recommendations include prevention strategies, prompt treatment, and continued follow-up within a dental care framework. The studies identified in this review encompassed data from five African countries. Further research involving diverse ethnic populations in Africa is essential to bridge existing knowledge gaps and contribute to the growing body of literature on this topic. Update Dent. Coll. j: 2023; 13(2): 42-44

Femoral Neck System versus Three Cannulated Screws for Fixation of Femoral Neck Fractures in Younger Patients: A Retrospective Cohort Study

Objective To compare the clinical results of a new femoral neck system (FNS) and cannulated compression screws (CCS) for the treatment of femoral neck fractures in younger patients. Methods Retrospective study was performed in younger patients with femoral neck fractures that were treated with FNS or CCS from August 2017 to August 2022. The hip functional outcomes were assessed with the Harris hip score (HHS). Secondary outcomes included the surgical time, surgical blood loss, satisfaction visual analog scale (VAS), fluoroscopy frequency, fracture healing time and complications. Results A total of 49 patients (22 FNS and 27 CCS) with a minimum follow-up of 12 months were included. There was also no significant difference in HHSs (p = 0.27) and satisfaction VAS (p = 0.10) between them. Patients with FNS had more blood loss (50.45 ± 5.28 mL vs. 20.67 ± 4.71 ml, p < 0.01), lower fluoroscopy frequency (16.64 ± 3.32 vs. 23.59 ± 3.39, p < 0.01) and lower fracture healing time (3.76 ± 0.42 vs. 4.46 ± 0.59 months, p < 0.01). The femoral neck shortening and incidence of nail withdrawal in the FNS group was significantly lower than CCS group (2.91 ± 1.95 vs. 4.44 ± 1.52 mm, p < 0.01; 4.5% vs. 22.2%, p = 0.03). Conclusions The FNS and CCS get similar hip functions. The FNS can reduce fluoroscopy exposure and the complications such as femoral neck shortening and nail withdrawal. Thus, FNS can be an alternative to CCS for the fixation of femoral neck fractures in younger patients.

Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient's Individual Type of Fracture and Its Treatment.

Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is "time-to-surgery". The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (n = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, p = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, p = 0.567). The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type.

3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture

PurposeThis study aimed to compare the effects of conventional surgery and three-dimension (3D) printing technology-assisted surgery in the treatment of posterolateral tibial plateau fractures (PTPF).MethodsA cohort of 61 patients afflicted with PTPF, spanning from June 2015 to October 2021, was enrolled. They were divided randomly into two groups: 31 cases of 3D printing group, 30 cases of conventional group. The personalized 3D-printed models were used to simulate the surgical procedures in 3D printing group. The demographic characteristics and clinical data were recorded, encompassing operation duration, intraoperative blood loss, intraoperative fluoroscopy shoots and fracture union time. The radiographic outcomes were gauged, encompassing tibiofemoral angle (FTA), tibial plateau angle (TPA), posterolateral slope angle (PSA) and Rasmussen’s anatomical score. The functional outcomes were assessed at the 12-month postoperative juncture, encompassing range of motion, Hospital for Special Surgery (HSS) score and Rasmussen’s functional score. Furthermore, fracture complications were evaluated,, encompassing infections, traumatic osteoarthritis, and delayed union.ResultsThe 3D printing group exhibited the operation time of 95.8 ± 30.2 min, intraoperative blood loss of 101.1 ± 55.3 ml, and intraoperative fluoroscopy shoots of 6.3 ± 2.3 times, while the conventional group recorded respective values of 115.5 ± 34.0 min, 137.0 ± 49.2 ml and 9.13 ± 2.5 times. Noteworthy disparities were evident between the conventional and 3D printing groups (p < 0.05). Furthermore, in comparison to the conventional group, the 3D printing group exhibited commendable radiological and functional outcomes both immediately and 12 months post-surgery, although statistical significance was not attained. Moreover, the 3D printing group experienced a paucity of complications compared to the conventional group, although without achieving statistical significance.ConclusionThis study demonstrated the clinical feasibility of 3D printing combined with anteroposterior cannulated screws for the treatment of posterolateral tibial plateau fracture.

First 100 total hip arthroplasties performed by a young surgeon using the direct anterior approach: learning curve and complications.

Most of the reported discussions about the learning curve for the direct anterior approach (DAA) in total hip arthroplasty (THA) have been by experienced surgeons. The study's aim was to describe the learning curve, short-term outcomes, complications, and adaptations to the DAA used in the first 100 THA cases experienced by a young surgeon who had received DAA training for trauma surgeries. This retrospective study summarizes the first 100 consecutive cases experienced by a young surgeon who performed the unilateral DAA for THA between 2019 and 2021. Cumulative sum (CUSUM) analysis was performed to evaluate the learning curve on the basis of operative time and overall complications. The demographics data, short-term outcomes, and complications of the first 50 and second 50 cases were compared. The CUSUM curve declined after 49 and 55 cases, measured by operative time and overall complications, respectively. The median operative time (104 vs. 80min) and intraoperative fluoroscopic time (38 vs. 12s) increased significantly in the first 50 cases compared with the times in the second 50 cases. Complications tended to occur in the first 50 cases (12% vs. 6%), and the overall rate was 9%. Major complications all occurred in the first 50 cases, with a rate of 4%. Only one case, which involved a complicated periprosthetic fracture around the stem that extended to the tip, required the intervention of a senior surgeon. Even after receiving training on the DAA for trauma surgeries, the young surgeon experienced a steep learning curve and more complications in the first 50 cases. The DAA for THA is a technically demanding procedure and may require guidance from an experienced surgeon to manage unexpected complications.

Obesity and Ankle Fractures: Are Outcomes and Complications Really Worse?

Category: Ankle; Trauma Introduction/Purpose: Existing literature has established that obese patients have nearly double the risk of sustaining an ankle fracture when compared to a non-obese population. However, few studies have investigated obesity’s effect on fracture complications and patient reported outcomes (PROs) when patients are stratified by fracture type. Furthermore, as the average body mass index (BMI) of our population steadily rises, it becomes prudent to investigate variations in complications rates and patient reported outcomes in various stages of obesity. The aim of this study is to identify trends in complication rates and patient reported outcome scores among patients of different BMI before and after dividing by fracture complexity. Methods: We retrospectively assessed clinical and surgical data from 595 patients who underwent ankle fracture surgery at a single institution between 2017 and 2021 for surgical related complications. All patients had a minimum of 18 months follow up (mean-42.2 [18.2-71.4] months). PROMIS Physical Health and Visual Analog Scale pain scores surveys were available only for patients receiving surgery after November 2019. We aggregated survey data for timepoints between three months and two years post-operatively to assess only patients with meaningful clinical data in regard to their recovery. Patients were divided based on BMI and fracture type. BMI subgroups were classified as: Non-obese (18.5-24.9 kg/m2, n=88), Overweight/Obese I (25-34.9 kg/m2, n=314), Obese II/III (≥35 kg/m2, n=192). Fracture subgroups were divided into two groups: Simple (Unimalleolar types) and complex (Bimalleolar and Trimalleolar variants). Data analysis was performed using Chi-Square and T-Tests with statistical significance set at an alpha (α) of ≤ 0.05. Results: We observed a whole cohort complication rate of (15.3%, n=91/594). Complication rates when stratified by BMI were: Non-obese (12.3%, n=9), Overweight/Obese class I (19.4%, n=61), Obese class II/III (10.3%, n=20). Complication rates for Overweight/Obese I patients were significantly higher when compared to Non-obese patients (p=0.044, OR=2.11). However, there was no significant difference when comparing Non-obese to Class II/III (p=0.972). We observed no significant differences in complications when performing a sub analysis on specific fracture types, regardless of BMI group. Pain scores were significantly higher in both Overweight/Obese I and Obese II/III groups when compared to Non-Obese patients (p= &lt; 0.001, p=0.015). Physical health scores were significantly lower only in the Obese II/III group when compared to Non-Obese patients (p=0.011). Conclusion: Our results indicate that patients who are Overweight/Obese I have a significantly higher risk of complication when compared to patients of normal BMI. Surprisingly, our cohort demonstrated nearly equivalent risk between Obese II/III and Non- obese patient groups. Patient reported outcome data shows different trends with worse pain scores and lower physical health outcomes in the Obese II/III group. These findings add to the growing debate surrounding obesity’s effect on ankle fracture complication rates as well as patient reported outcomes and suggest that increased BMI cannot be viewed purely as a one-to-one relationship with negative outcomes.