Body Mass Index and Outcomes After Pilon Fracture Fixation: A Retrospective Cohort Study

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Biomechanics

Background:

• Pilon fractures are severe distal tibial plafond fractures with high complication rates.
• Obesity, indicated by body mass index (BMI), is often linked to poorer surgical outcomes in trauma patients.

Purpose of the Study:

• To investigate the association between body mass index (BMI) and post-operative outcomes following surgical fixation of pilon fractures.
• To determine if elevated BMI is a predictor of complications such as infection, nonunion, and post-traumatic osteoarthritis (PTOA).

Main Methods:

• Retrospective review of 132 patients with pilon fractures undergoing surgical fixation (January 2013 - June 2023).
• Inclusion criteria: minimum 6-month follow-up.
• Analysis included bivariate and multivariate models, with various BMI cutoffs (≥30, ≥35, ≥40, ≥45) to assess outcomes.

Main Results:

• No significant relationship was found between BMI and infection, nonunion, or PTOA rates on bivariate analysis (P > .05).
• Multivariate analysis identified diabetes mellitus as a risk factor for infection (P = .01), but BMI was not a predictor of any outcomes.
• Different BMI cutoffs did not yield significant differences in complication rates.

Conclusions:

• Body mass index (BMI) is not an independent predictor of post-operative complications in patients with pilon fractures.
• Pilon fractures may have unique healing characteristics that differ from other lower-extremity injuries regarding weight-bearing protocols.
• Further research in larger cohorts with long-term follow-up is needed to confirm these findings.