Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY.
J Orthop Trauma. 2024 Jul 1;38(7):366-372. doi: 10.1097/BOT.0000000000002813.
To evaluate the association between obesity and treatment approaches, perioperative factors, and clinical and radiographic outcomes following subtrochanteric fracture fixation.
Retrospective Cohort.
Academic Medical Center.
Patients operatively treated for an AO/OTA 32Axa, 32Bxa, or 32Cxa subtrochanteric femur fracture.
Injury characteristics, perioperative parameters, fixation information, postoperative complications, and clinical and radiographic outcomes. Univariate analyses were conducted between the obese (BMI ≥30 kg/m2) and the nonobese (BMI <30 kg/m2) cohorts. Regression analyses were performed to assess BMI as a continuous variable.
Of 230 operatively treated subtrochanteric fracture patients identified, 49 (21%) were obese and 181 (79%) were nonobese. The average age of the obese cohort was 69.6 ± 17.2 years, with 16 (33%) male and 33 (77%) female. The average age of the nonobese cohort was 71.8 ± 19.2 years, with 60 (33%) male and 121 (77%) female. Aside from BMI, there were no significant differences in demographics between the obese and nonobese (age [P = 0.465], sex [P = 0.948], American Society of Anesthesiology Score [P = 0.739]). Both cohorts demonstrated similar injury characteristics including mechanism of injury, atypical fracture type, and AO/OTA fracture pattern (32A, 32B, 32C). Obese patients underwent more open reduction procedures (59% open obese, 11% open nonobese, P < 0.001), a finding further quantified by a 24% increased likelihood of open reduction for every 1 unit increase in BMI (OR: 1.2, 95% CI, 1.2-1.3, P < 0.001). There was no difference in average nail diameter, 1 versus 2-screw nail design, or number of locking screws placed. The obese cohort was operated more frequently on a fracture table (P < 0.001) when compared with the nonobese cohort that was operated more frequently on a flat table (P < 0.001). There were no significant differences (P > 0.050) in postoperative complications, mortality/readmission rates, hospital quality measures, fixation failure, or time to bone healing.
The treatment of subtrochanteric fractures in obese patients is associated with a higher likelihood of surgeons opting for open fracture reduction and the use of different operating room table types, but no difference was observed in postoperative complications, mortality or readmission rates, or healing timeline when compared with nonobese patients.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估肥胖与治疗方法、围手术期因素以及转子下骨折固定术后临床和影像学结果之间的关系。
回顾性队列研究。
学术医疗中心。
接受手术治疗的 AO/OTA 32Axa、32Bxa 或 32Cxa 转子下股骨骨折患者。
损伤特征、围手术期参数、固定信息、术后并发症以及临床和影像学结果。对肥胖（BMI≥30kg/m2）和非肥胖（BMI<30kg/m2）队列进行单变量分析。采用回归分析评估 BMI 作为连续变量的影响。
在 230 例接受手术治疗的转子下骨折患者中，49 例（21%）为肥胖患者，181 例（79%）为非肥胖患者。肥胖组的平均年龄为 69.6±17.2 岁，其中 16 例（33%）为男性，33 例（77%）为女性。非肥胖组的平均年龄为 71.8±19.2 岁，其中 60 例（33%）为男性，121 例（77%）为女性。除 BMI 外，肥胖组和非肥胖组在人口统计学方面无显著差异（年龄[P=0.465]，性别[P=0.948]，美国麻醉医师协会评分[P=0.739]）。两组患者的损伤特征均相似，包括损伤机制、非典型骨折类型和 AO/OTA 骨折类型（32A、32B、32C）。肥胖患者更倾向于接受开放复位手术（59%肥胖患者采用开放复位，11%非肥胖患者采用开放复位，P<0.001），BMI 每增加 1 个单位，接受开放复位的可能性就会增加 24%（OR：1.2，95%CI，1.2-1.3，P<0.001）。两组的平均钉直径、1 枚或 2 枚螺钉设计或锁定螺钉数量无显著差异。肥胖组更常在骨折桌上进行手术（P<0.001），而非肥胖组更常在平桌上进行手术（P<0.001）。两组在术后并发症、死亡率/再入院率、医院质量指标、固定失败或骨愈合时间方面无显著差异（P>0.050）。
在肥胖患者中治疗转子下骨折与外科医生更倾向于选择开放性骨折复位以及使用不同的手术室台类型有关，但与非肥胖患者相比，术后并发症、死亡率或再入院率或愈合时间无差异。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
