Periarticular tibial fracture treatment in the obese population

Lambotte's 7 steps of fracture treatment have stood the test of time. Incision, preparation of the bone ends, reduction, temporary fixation, permanent fixation, closure, and dressing are modified to suit the needs of each fracture and each patient. One specific patient characteristic, obesity, has provided complex challenges in fracture care. This article reviews the challenges of obesity as they relate to the 7 steps of lower extremity periarticular fracture care. Specifically, helpful modifications to these 7 steps are provided for the treatment of tibial plateau fractures and tibial plafond fractures. As there is little published evidence with respect to the treatment of these injuries in the obese population, the suggestions that are provided are based on the extrapolation from published evidence of fracture care in other areas in patients with obesity, logic, and personal experience with fracture care in patients with obesity.