title: Severity of injury and outcomes among obese trauma patients with fractures of the femur and tibia: a crash injury research and engineering network study.
abstract: OBJECTIVE
  To understand the influence of obesity on the morbidity and mortality outcomes of patients who have sustained fractures of the femur and tibia.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Multicenter level I trauma facilities.
  
  
  METHODS
  Motor vehicle crash victims enrolled in multicenter databases were reviewed.
  
  
  METHODS
  Outcome measurements for obese (body mass index, BMI > or = 30 kg/m) versus nonobese (BMI < 30 kg/m) patients included Injury Severity Score, Abbreviated Injury Scores, OTA fracture types, length of hospital stay, disposition, complications, and 36-Item Short Form Survey Instrument.
  
  
  RESULTS
  We included 665 cases from the database, of which 461 (69%) were nonobese and 204 (31%) were obese. There was no difference in sex, mechanism of injury, Injury Severity Score, and Abbreviated Injury Score. The obese population was older with a mean age of 44 years compared with 41 years for the nonobese (P < 0.01) and had a greater incidence of reported baseline cardiac disease (P < 0.01) and diabetes (P < 0.01). Obese patients had more severe injury patterns (OTA B and C type) in the distal femur fractures (90% versus 61%, P < 0.01). Mortality rates did not show a statistically significant difference (5.6% versus 9.4%, P = 0.07). The baseline physical component on the 36-Item Short Form Survey Instrument was lower among the obese but not statistically different (P = 0.08). At 6 and 12 months post injury, a decline was noted in both groups; however, no differential decline was noted between the groups (P > 0.05).
  
  
  CONCLUSIONS
  Obese patients are significantly more likely to have more severe distal femur fractures compared with nonobese when involved in motor vehicle crashes. In this study, there was no statistically significant difference in length of stay, complications, or mortality in obese patients.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University ofWashington, 1959 NE Pacific St, PO Box 356500, Seattle, WA 98195, USA. rm15@u.washington.edu
authors.forename: Rajshri
authors.initials: R
authors.lastname: Maheshwari
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Mack
authors.forename: Robert P
authors.initials: RP
authors.lastname: Kaufman
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Sean E
authors.initials: SE
authors.lastname: Nork
authors.forename: M Bradford
authors.initials: MB
authors.lastname: Henley
mesh_terms: D000063:Accidents, Traffic / Q000145:classification / Q000401:mortality; D000328:Adult; D016208:Databases, Factual; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D007902:Length of Stay; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013978:Tibial Fractures / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome