PAPER 124: MORBID OBESITY: IS OPERATIVE TREATMENT OF DISPLACED ACETABULAR FRACTURES WORTH THE RISK?

Abstract

Purpose: Displaced acetabular fractures require operative intervention for optimal results. Obesity and morbid obesity is becoming more prevalent. Morbid obesity is defined as a body-mass index (BMI) > 40. The purpose of this investigation is to evaluate the early results of operative treatment of acetabular fractures in morbidly obese patients.

Method: A prospectively gathered database demonstrated 349 patients who underwent ORIF for acetabular fractures over a 60 month period. Of those patients, 39 were morbidly obese. Patient weights were collected from anesthesia records. There were 15 posterior wall, 10 transverse/posterior wall, 5 T-type, 3 transverse, 3 anterior column/posterior hemi-transverse, 1 anterior column, 1 posterior column/posterior wall, and 1 both column fractures. Early results of morbidly obese patients (Group 1) were reviewed. Perioperative complications were compared to patients with BMI < 40 (Group 2). Factors evaluated were: estimated blood loss, operative time, length of hospital stay, and overall complication rate (as defined by wound complications or heterotopic ossification requiring subsequent surgery, failure of fixation, nerve palsy, death).

Results: Follow up ranged from 6–48 months. Fracture reductions were perfect in 23, imperfect in 10, and poor in 6. Fixation failure was noted in 9 patients and typically associated with comminuted posterior wall fractures. Eight patients developed deep infections necessitating debridements. Nine patients required secondary surgery for wound healing problems. Of those, 6 required one additional surgery, three required 2, two required 3, one required 5, and one required 12 additional surgeries. Six patients proceeded to THA and two of those required revisions. The average EBL was 903cc in group 1 versus 630cc in group 2 (p < 0.044). Operative time averaged 293 minutes in group 1 versus 250 in group 2 (p< 0.008). Hospital stay for group 1 averaged 26 days versus 15 days in group 2 (p< 0.008). Complication rate for group 1 was 67% versus 16% in group 2.

Conclusion: This data shows that there is a significant increase in estimated blood loss, operative time, and length of hospital stay. Moreover, the risk of complications should be heavily weighed prior to operative intervention