Operative experience of pelvic fractures in the obese.
BACKGROUND
Disruptions of the pelvic ring may be a significant short- or long-term source of morbidity and mortality. In the obese, temporary stabilization and definitive fixation of the injured pelvis is a much more difficult undertaking, requiring more surgeon expertise and larger surgical approaches. Complications that arise as a result of the operative fixation of pelvic ring injuries may significantly minimize any potential long-term benefits conferred by attempts at fixation.


METHODS
During a continuous 46-month period, 288 patients with pelvic ring injuries were prospectively enrolled into a database. A cohort of 186 nonobese patients (group 1) was compared to the cohort of 102 obese patients (group 2). Injury patterns were classified and outcome variables were grouped into perioperative variables, perioperative complications, and late complications.


RESULTS
Injury patterns differed significantly between the two groups. There was an increase in the perioperative variables. Overall, there were complications in 19% of nonobese patients and 39% of obese patients (p < 0.001). Wound complications dominated in the obese group. There were 64 additional surgeries in 30 (16%) patients that were the direct result of complications in group 1 and 62 additional surgeries in 31 (31%) patients in group 2.


CONCLUSIONS
In the obese, the time commitment, postoperative complication rate, and subsequent surgery rate are significantly greater. In this patient population, special attention should be focused on operative and soft tissue techniques in an effort to lessen the infection risk, the most likely cause of morbidity.
Porter
Scott E
SE
Department of Orthopaedic Surgery, University of Mississippi Medical Center, 2500 North State St., Jackson, MS 39216, USA. sporter@orthopedics.umsmed.edu
Graves
Matt L
ML
Qin
Zhen
Z
Russell
George V
GV
D000293:Adolescent; D000328:Adult; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009765:Obesity; D009767:Obesity, Morbid; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D011183:Postoperative Complications