Japa Jonathan P, Shats Alina, Zitser Philip, Lakhi Nisha
School of Medicine, New York Medical College, Valhalla, NY, USA.
The University of Tampa, Tampa, FL, USA.
Open Access Emerg Med. 2025 May 17;17:185-193. doi: 10.2147/OAEM.S490123. eCollection 2025.
Obese trauma patients face a higher risk of mortality, prolonged ICU stays, and more complications than non-obese patients. However, some studies suggest that obesity might provide protective benefits in high-impact trauma situations through the "cushion effect". This study will examine whether obesity influences fracture occurrence, injury severity, and clinical outcomes in motor vehicle accidents (MVA).
A retrospective study of 555 adult patients who presented to a Level 1 Trauma Center following a MVA from 2010-2022. Patients with a Body Mass Index (BMI) greater than or equal to 30 kg/m were categorized as obese (178 patients, 32.6%), and those with a BMI less than 30 kg/m were classified as non-obese (377 patients, 67.4%). Incidence of bone fractures and injury severity were compared between both groups using injury severity score (ISS) and abbreviated injury scale (AIS). For variables significant on univariate analysis, binary logistic regression models were used to control age, gender, restraint use, and airbag deployment.
The mean number of fractures (0.62 vs 0.46, p=0.096) and ISS (4.55 vs 4.51, p=0.703) were similar between the obese and non-obese groups. However, obese patients were more likely to experience upper extremity fractures (7.3% vs 3.4%, p=0.045) and lower extremity fractures (7.3% vs 2.7%, p =0.01), particularly fractures of the tibia/fibula (5.6% vs 1.6%, p=0.008). No significant differences were found in the incidence of head, thoracolumbar, or pelvic fractures between the two groups. After controlling for age, gender, restraint use, and airbag deployment, obesity remained an independent predictor of lower extremity fracture (aOR) 2.62 (95% CI: 1.01-6.56), p = 0.04).
Obesity is an independent predictor of lower extremity fractures following a MVA. Clinicians should acknowledge potential differences in fracture occurrence and patterns between obese and non-obese patients during triage.
与非肥胖创伤患者相比，肥胖创伤患者面临更高的死亡风险、更长的重症监护病房（ICU）住院时间以及更多的并发症。然而，一些研究表明，在高冲击力创伤情况下，肥胖可能通过“缓冲效应”提供保护作用。本研究将探讨肥胖是否会影响机动车事故（MVA）中的骨折发生率、损伤严重程度及临床结局。
对2010年至2022年期间因MVA就诊于一级创伤中心的555例成年患者进行回顾性研究。体重指数（BMI）大于或等于30kg/m²的患者被归类为肥胖患者（178例，32.6%），BMI小于30kg/m²的患者被归类为非肥胖患者（377例，67.4%）。使用损伤严重程度评分（ISS）和简明损伤定级（AIS）比较两组之间的骨折发生率及损伤严重程度。对于单因素分析中有统计学意义的变量，采用二元逻辑回归模型控制年龄、性别、安全带使用情况及安全气囊展开情况。
肥胖组与非肥胖组的平均骨折数量（0.62对0.46，p = 0.096）及ISS（4.55对4.51，p = 0.703）相似。然而，肥胖患者更易发生上肢骨折（7.3%对3.4%，p = 0.045）及下肢骨折（7.3%对2.7%，p = 0.01），尤其是胫腓骨骨折（5.6%对1.6%，p = 0.008）。两组之间的头部、胸腰椎或骨盆骨折发生率无显著差异。在控制年龄、性别、安全带使用情况及安全气囊展开情况后，肥胖仍然是下肢骨折的独立预测因素（调整后比值比[aOR]为2.62，95%置信区间[CI]：1.01 - 6.56，p = 0.04）。
肥胖是MVA后下肢骨折的独立预测因素。临床医生在分诊时应认识到肥胖与非肥胖患者在骨折发生率及骨折类型上的潜在差异。
