title: Morbid obesity increases the risk for systemic complications in patients with femoral shaft fractures.
abstract: OBJECTIVE
  To determine whether morbidity and mortality were increased in morbidly obese patients who had reamed intramedullary nailing of closed femoral shaft fractures compared with similar patients of normal weight.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  All patients with closed femoral shaft fractures treated with reamed intramedullary nailing over a 5-year period were identified. Normal-weight patients (BMI < 25) were compared with overweight (25 ≤ BMI < 30), obese (30 ≤ BMI < 40), and morbidly obese patients (BMI ≥ 40).
  
  
  METHODS
  Reamed intramedullary nailing.
  
  
  METHODS
  Occurrence of postoperative complications.
  
  
  RESULTS
  Of 507 patients with 526 femoral shaft fractures (AO/OTA-32), 184 (36.3%) were of normal weight, 170 (33.5%) were overweight, 114 (22.5%) were obese, and 39 (7.7%) were morbidly obese. There were no significant differences in complications when comparing normal-weight patients with overweight and obese patients. Systemic complications occurred in 23% of morbidly obese and 9% of normal-weight patients [odds ratio (OR) = 3.15, P = 0.013]. Morbid obesity increased odds of adult respiratory distress syndrome (OR = 35.38, P = 0.019) and sepsis (OR = 6.49, P = 0.0015). Overall, morbidly obese patients with a femoral fracture had a mortality rate of 10%, but a subset of polytraumatized patients (Injury Severity Score > 17) had a mortality rate of 20%. Morbid obesity significantly increased the odds of mortality (OR = 46.77, P = 0.01). Body mass index was found to be an independent predictor of adult respiratory distress syndrome, sepsis, and death.
  
  
  CONCLUSIONS
  Morbid obesity is a significant risk factor for systemic complications in patients with closed femoral shaft fractures, especially in polytraumatized patients. Patients and their families need to be counseled regarding the high risk of morbidity and mortality.
  
  
  METHODS
  Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
authors: *Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN; and †University of Tennessee School of Medicine, Memphis, TN.
authors: John C
authors: JC
authors: Weinlein
authors: Stuart
authors: S
authors: Deaderick
authors: Robert F
authors: RF
authors: Murphy
mesh_terms: D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D012189:Retrospective Studies; D055815:Young Adult