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Body Mass Index and Outcomes After Pilon Fracture Fixation: A Retrospective Cohort Study
Julia E Ralph1, Crystal Jing1, Jackson Cathey1
1Duke University School of Medicine, Durham, NC, USA.
Insights
Body mass index (BMI) did not predict complications after pilon fractures. This study suggests pilon fractures may not require the same weight-based postoperative care as other lower-extremity injuries.
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.
Background:
Pilon fractures of the distal tibial plafond account for 1% to 10% of all tibial fractures and are often associated with serious complications. As body mass index (BMI) is known to impact post-operative outcomes, particularly infection and nonunion, after trauma, the goal of this study is to explore these trends after pilon fractures.
Methods:
A single-center retrospective review of patients undergoing surgical fixation for pilon fractures between January 2013 and June 2023 was conducted. Only patients with at least a 6-month follow-up period were included. Demographic data and injury characteristics were extracted. Post-operative outcomes and complications were computed. Bivariate analysis via t test were applied, followed by multivariate analysis using primary and reduced models to evaluate for poor outcomes. Various BMI cutoffs (≥30, ≥35, ≥40, ≥45) were also employed to evaluate the relationship between outcomes and various obesity categories. Nonunion was assessed at ≥6 months postoperatively.
Results:
There were 132 patients included. There was no significant relationship between BMI and infection rates, nonunion rates, and development of post-traumatic osteoarthritis (PTOA) on bivariate analysis (P > .05). On multivariate analysis, diabetes mellitus was a risk factor for infection (P = .01), but BMI was not predictive of any outcomes in the primary or reduced models (P > .05). There were no significant differences in infection, nonunion, and PTOA rates when employing various BMI cutoffs (P > .05).
Discussion:
BMI was not found to be an independent predictor of post-operative complications in patients with pilon fractures in this cohort. Our study suggests that pilon fractures are unique and counter historic lower-extremity injury postoperative care protocols that consider weight, although further investigation in larger cohorts with long-term follow-up is required to define this trend.
Level Of Evidence:
Level III, retrospective cohort series.
