title: Is obesity protective against wound healing complications in pilon surgery? Soft tissue envelope and pilon fractures in the obese.
abstract: Open treatment of pilon fractures is associated with wound healing complications. A traumatized, limited soft tissue envelope contributes to wound healing complications. Obese patients have larger soft tissue envelopes around the ankle, theoretically providing a greater area for energy distribution and more accommodation to implants. This led us to test 2 hypotheses: (1) ankle dimensions in obese patients are larger than in lean patients, and (2) the increased soft tissue envelope volume translates into fewer wound complications. A consecutive series of 176 pilon fractures treated from March 2002 to December 2007 were retrospectively reviewed. Inclusion criteria were adults who received a preoperative computed tomography (CT) scan and were treated with a staged protocol including plating. Patients with body mass index (BMI) >30 were compared to those with BMI <30 for CT-derived ankle dimensions and wound complications. Comorbidities were evaluated for their role as potential confounders. Thirty-one fractures in obese patients were compared to 83 in lean patients. The average ratio of bone area to soft tissue area at the tibial plafond was 0.35 for the obese group and 0.38 for the lean group (P=.012). There were 8 major wound-healing complications. Four occurred in the obese group (incidence 13%), and 4 in the lean group (incidence 5%) (P=.252). Ankle dimensions in clinically obese patients are larger than in lean patients. Obesity does not appear to be protective of wound-healing complications, but rather there is a trend toward the opposite.
authors: Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA. mgraves@orthopedics.umsmed.edu
authors: Matthew L
authors: ML
authors: Graves
authors: Scott E
authors: SE
authors: Porter
authors: Bryan C
authors: BC
authors: Fagan
authors: Glenn A
authors: GA
authors: Brien
authors: Matthew W
authors: MW
authors: Lewis
authors: Marcus D
authors: MD
authors: Biggers
authors: James R
authors: JR
authors: Woodall
authors: George V
authors: GV
authors: Russell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015992:Body Mass Index; D003646:Debridement; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents