Correlation between obesity and severity of distal radius fractures

Impact of body mass index on fracture severity, clinical, radiological and functional outcome in distal radius fractures: a retrospective observational study after surgical treatment

INTRODUCTION

Distal radius fracture (DRF) is one of the three most common fractures of the human body with increasing incidences in all groups of age. Known causes of increasing incidence, such as ageing of the population or increased obesity, have been described and discussed. So far, literature reports ambivalent effects of body mass index (BMI) on bone physiology. It is worthwhile to examine the influence of BMI on the outcome of fractures more detailed. This study aims to investigate the influence of an abnormal BMI on fracture severity and treatment, as well as clinical, radiological, and functional outcome to improve clinical decision making.

MATERIALS AND METHODS

A retrospective observational study was conducted on data obtained from patients, who underwent open reduction and internal fixation (ORIF) of a DRF at a local Level 1 Trauma Center between May 2018 and October 2021. Follow-up examinations were performed approximately 1 year after surgical fracture treatment, during which various questionnaires and functional measurements (CMS, DASH, NRS, ROM) were applied. In addition, postoperative complications were recorded and radiological examinations of the affected hand were performed. After excluding incomplete data sets and applying set exclusion criteria, the complete data of 105 patients were analyzed.

RESULTS

74 patients were female and 31 male with significant difference in mean BMI [p = 0.002; female: 23.8 (SD ± 3.3), men: 26.2 (SD ± 3.9)]. Patients with higher BMI had significantly more severe fractures (p = 0.042). However, there was no significant difference in surgery time for fracture management. At follow-up, patients with lower BMI showed a smaller difference in hand strength between the fractured and the other hand (p = 0.017). The BMI had no significant effect on the clinical and radiological outcome.

CONCLUSION

Despite the ambivalent effects of BMI on the skeletal system, our findings indicate that a higher BMI is associated with more severe DRF. Thereby BMI does not correlate with surgery time for fracture treatment. Furthermore, no evidence of an influence on the clinical and radiological outcome could be detected.

Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture

BACKGROUND

Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures.

METHODS

We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA.

RESULTS

The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; p<0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; p=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD.

CONCLUSIONS

Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.

Development and Trial of a Prototype Device for Sensorimotor Therapy in Patients with Distal Radius Fractures

This study examined the clinical feasibility of a prototype device (development name: Ghost) for facilitating range of motion (RoM) recovery in the acute phase in patients with distal radius fractures (DRF). The Ghost device involves the administration of a combination of vibratory and visual stimuli. We divided the patients into the Ghost (n = 10) and control group (n = 4; tendon vibration only) groups. The experimental interventions were administered between the day after surgery and day 7 postoperatively. Traditional hand therapy was provided to both groups once daily from day 7 until day 84 postoperatively and once a week from day 84 until the end of the intervention period. Because vibratory stimulation makes the patient focus on wrist flexion, the primary outcome was the arc of wrist flexion-extension on the injured side, which was measured on days 7, 14, 28, 42, 56, 70, and 84. Analysis of covariance was applied using a bootstrap method to evaluate changes over time and compare them between the groups. Analyses was performed after stratification by age and body mass index. Both interventions improved RoM over time in patients with DRF. Results showed that Ghost has greater efficacy for improving wrist RoM in DRF patients than vibration alone. Treatment with Ghost can result in good RoM improvement during the acute phase of DRF in young patients and those with and normal or low body mass index. Further study is needed to verify our findings and assess the extent of RoM recovery.

Association Between Body Mass Index and Functional Outcomes in Elderly Patients with Extra-articular Distal Radius Fracture: A Prospective Observational Study

INTRODUCTION

The association between body mass index (BMI) and functional outcomes is unknown in elderly individuals with distal radius fracture (DRF).

OBJECTIVE

The aim of this study is to evaluate if there is association between BMI and functional outcomes in patients older than 60 years with DRF treated conservatively.

MATERIALS AND METHODS

A prospective observational study was performed. A total of 228 patients with extra-articular DRF were prospectively recruited. All patients were categorized by their BMI as normal, overweight, or obese. Functional outcomes were assessed after cast removal and at 1-year follow-up. The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to assess upper limb and wrist/hand function, respectively, while the Jamar Dynamometer was used to assess grip strength.

RESULTS

Of the total number of patients, 184 were female (80.7%), 87 were overweight (38.2%), and 111 were obese (48.7%). After cast removal, the correlations between BMI and functional outcomes were DASH 0.06 (p = 0.578), PRWE 0.04 (p = 0.692), and grip strength - 0.02 (p = 0.763). At 1-year follow-up, the correlations were DASH 0.55 (p = 0.036), PRWE 0.32 (p = 0.041), and grip strength - 0.21 (p = 0.043).

CONCLUSION

This study suggests that at 1-year follow-up, there was a low-to-moderate association between BMI and poor functional outcomes in elderly patients with extra-articular DRF treated conservatively.

LEVEL OF EVIDENCE

Level IV, observational prospective study.

Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

BACKGROUND

The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children.

METHODS

We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed.

RESULTS

In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320-3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169-3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975-5.421).

CONCLUSIONS

Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

Elevated BMI is associated with intra-articular comminution, prolonged operative time, and postoperative complications in distal radius fractures

INTRODUCTION

Obesity continues to be a problem in the United States with greater than 35% of the adult population affected. Obesity influences fracture care as it affects impact forces, alters cellular pathways of healing, and is often associated with higher complication rates. Distal radius fractures are among the most common fracture patterns in the adult population. The purpose of this study was to evaluate the effect of BMI on the degree of intra-articular fracture comminution, operative time, and return to the OR in obese patients who underwent operation for distal radius fractures.

METHODS

A retrospective analysis of the American College of Surgeons National Surgical Improvement Program's (ACS-NSQIP) database was performed and logistic regressions were used to assess the relationship between BMI and open treatment of distal radius fractures. Three separate CPT codes were used to distinguish between extra-articular fractures, intra-articular split fracture, and intra-articular fracture with comminution. Percutaneous or closed treatment of distal radius fractures were excluded.

RESULTS

A total of 11,228 patients (mean age 65.1 years) with open reduction and internal fixation of distal radius fractures were identified. For every increase in BMI point, there was an increased risk of intra-articular split fracture by 1.7% (OR 1.017, 95% CI 1.010-1.023, p < 0.01) and increased risk of intra-articular comminution by 3.1% (OR 3.1, 95% CI 1.025-1.037, p < 0.01). Additionally, for every increase in BMI point, the risk of a surgical complication increased by 2.3% DISCUSSION: This nationally representative, population-based study demonstrates that elevated BMI is associated with increased risk for intra-articular involvement and higher risk for post-operative complications. Our results can be useful to patients and orthopedic surgeons as prognostic information for counseling patients on expectations following open reduction and surgical fixation of distal radius fractures.

LEVEL OF EVIDENCE

Case-control study. Level III.

A Qualitative Study Assessing Information on the Internet Compared With AAOS Guidelines for the Treatment of Distal Radius Fractures

The goal of this study was to compare information available on the Internet about the treatment of distal radius fractures with the guidelines established by the American Academy of Orthopaedic Surgeons (AAOS) in a qualitative observational study. A scoring system was used to compare the top 20 websites, excluding advertisements, from Google, Bing, and Yahoo with the AAOS guidelines. In addition, the results of the advertising content and the social media content were discussed. Of the 32 unique websites included in the study, 22 (68.75%) suggested operative fixation for fractures with unacceptable postreduction alignment (radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement or step-off >2 mm) as opposed to cast fixation. Of the 32 sites, 26 (81.25%) were unable to recommend for or against any 1 specific operative method for fixation of distal radius fractures. Only 2 of 32 (6.25%) sites mentioned age-specific recommendations, and 6 of 32 (18.75%) mentioned accurate activity protocols. Because the AAOS cannot recommend for or against immobilization of the elbow in patients treated with cast immobilization, it is reasonable that 7 of 32 (21.88%) sites discussed these options. The websites common to all 3 search engines also scored very well, with 84.89% of their recommendations being consistent with the AAOS recommendations. Most websites contain appropriate recommendations for the treatment of distal radius fractures. However, there is a significant amount of misinformation as well. The available information may be difficult for patients to interpret and may affect their expectations about care. [Orthopedics. 2020;43(2):e79-e86.].

Influence of body mass index on health-related quality of life after surgical treatment of intra-articular distal radius fractures. A retrospective 7-year follow-up study

Morbid obesity is associated with reduced health-related quality of life (HRQOL), increased morbidity and mortality. Little is known about the correlation between obesity and complex distal radius fractures (DRF). The purpose of this study was to examine the effect of being overweight on postoperative HRQOL after surgically treated intra-articular DRF. Fifty-three patients were included in this retrospective study with 7 years' mean follow-up (mean 7.2±0.4, range 6.4-7.9 years) after volar plating of an intra-articular DRF (AO-type C). All patients were categorized by their body mass index (BMI) into two study groups: group 1 (normal weight) with a BMI<25 (n=24); group 2 (obese) with a BMI≥25 (n=29). HRQOL and functional outcomes were assessed through range of motion (ROM) and four different scores - the 36-item short form health survey (SF-36), the disability of arm and shoulder score (DASH), the Gartland and Werley score and the Castaing score - along with X-rays to measure volar tilt, radial inclination, radial length and articular congruity. All HRQOL assessments and clinical outcomes were correlated to BMI by comparing group 1 versus group 2. There was no difference in terms of postoperative ROM. The group of normal weight patients achieved slightly better but non-significant results for the Gartland and Werley score. No differences were seen in the DASH score or SF-36. There were also no differences regarding the Castaing score. Overall, normal and obese patients had no significant differences their HRQOL and functionality after volar plating of DRF.

The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures

PURPOSE

Distal radius fractures are common fractures of the upper extremity. Whereas surgical outcomes have been extensively investigated, the impact of risk factors such as body mass index (BMI) and smoking on patient outcomes has not been explored. We hypothesized that obesity and smoking would have a negative impact on the functional and radiographic outcomes of surgically treated patients with distal radius fractures.

METHODS

We performed a retrospective analysis of patients surgically treated for a distal radius fracture between 2006 and 2017 at 2 level 1 trauma centers. Patients were divided into obese (BMI ≥ 30) and nonobese (BMI < 30) groups according to the World Health Organization BMI Classification. Patients were also divided into current, former, and never smokers based on reported cigarette use. Primary outcomes included patient-reported outcome measures (Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]), range of motion (ROM) arc (flexion-extension, pronation-supination), radiographic union (Radiographic Union Scoring System [RUSS] score), and change in radiographic alignment (radial height, radial inclination, volar tilt) between first and last follow-up. Multivariable models corrected for age, sex, comorbidities, fracture complexity, osteoporosis, and time to surgery.

RESULTS

Two hundred patients were identified, 39 with BMI of 30 or greater and 161 with BMI less than 30. Obese patients had more comorbidities but similar fracture types. At 3-month and 1-year follow-up, both groups achieved acceptable QuickDASH scores, close to those of the general population (21 vs 18, 14 vs 2, respectively). The 2 groups were similar in regard to motion, RUSS score, and alignment. There were 148 never smokers, 32 former smokers, and 20 current smokers. At 3 months, smokers demonstrated higher QuickDASH scores (42 vs 21-24) and a lower percentage of radiographically healed fractures (40% vs 69%-82%). At final follow-up, smokers reported small differences in patient-reported outcomes (QuickDASH 18 vs 9-13) whereas ROM, fracture healing, and complication rates were similar.

CONCLUSIONS

Both obese and nonobese patients can achieve excellent outcomes following surgical treatment of distal radius fracture with similar self-reported outcomes, motion, RUSS score, and alignment. Despite slower healing in the early postoperative period, smokers had similar QuickDASH scores, ROM, and union rates to past smokers and never smokers at final follow-up, with a similar complication profile.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Obesity in the Polytrauma Patient

The rates of obesity continue to increase in the United States and the overall impact of obesity on health care spending and patient outcomes after trauma is considerable. The unique physiology of the obese places them at higher risk for complications, including infection, failure of fixation, nonunion, multiorgan failure, and death. These physiologic differences and overall patient size can make orthopedic care in obese patients with trauma more difficult, but appropriate initial resuscitation, careful preoperative planning, meticulous surgical technique, diligent postoperative medical management, and specialized rehabilitation give these patients their best opportunity for a good outcome.