American Association for Hand Surgery
Theme: Beyond Innovation

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Obesity Negatively Impacts Functional Outcomes After Distal Radius Fracture Surgery
Abbas Peymani, MD MS1; Matthew Hall, MD1; Peter J. Ostergaard, MD1; Arriyan Samandar Dowlatshahi, MD2; Carl M Harper, MD2; Brandon E. Earp, MD3; Tamara Rozental, MD1;
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 2Beth Israel Deaconess Medical Center, Boston, MA, 3Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Introduction
Distal radius fractures are among the most common types of fractures. While risk factors and outcomes have been extensively investigated for treatment of these injuries, the associations between body mass index (BMI) and outcomes have not been explored. The purpose of this study was to investigate the effect of BMI on functional, radiographic, and patient-reported outcomes following distal radius fractures treated both operatively and non-operatively, using our multi-institutional distal radius fracture patient cohort. We hypothesized that obese patients would have worse outcomes than the non-obese patient cohort.

Materials & Methods
We performed a retrospective analysis for patients treated for a distal radius fracture between 2006 and 2017. Patients were divided into non-obese (BMI<30) and obese (BMI?30) groups according to the World Health Organization BMI Classification. Primary outcome measures were QuickDASH scores, range of motion (flexion/extension, pronation/supination), and change in radiographic parameters (radial height, radial inclination, volar tilt) between first and last follow-up. The Chi-square test, Fisher's exact test, and t-test were used in univariate analyses. Multivariate models corrected for age, gender, smoking, AO classification, hand dominance, and comorbidities (diabetes, coronary artery disease, hypertension, osteoarthritis, and peripheral vascular disease).
Results
A total of 581 patients were identified, of which 361 were treated surgically and 320 were treated conservatively. Obese patients had a higher number of comorbidities and were slightly younger than non-obese patients; fracture types were similar between groups (Table 1). Post-treatment complication rates were low and did not differ significantly. In univariate analyses (Table 2), obesity was associated with significantly higher QuickDASH-scores (26.6 28.0 vs. 16.3 19.7; P=0.019), decreased flexion-extension (104.1 38.1 vs. 119.1 36.8; P=0.015) and decreased pronation/supination (157.0 31.7 vs. 168.3 22.0; P=0.041) in surgically treated patients. These associations remained significant in multivariate analyses, with significantly higher QuickDASH-scores (+14.9; P=0.043), decreased flexion/extension (-34.7; P=0.006), and decreased pronation/supination (-28.1; P=0.003) per SD increase in BMI (Table 3). No significant associations were found between obesity/BMI and outcomes in patients treated conservatively.
Conclusions
There is a significant association between obesity and worse functional outcomes following surgical treatment of distal radius fractures. Despite similar radiographic parameters, obese patients show worse self-reported outcomes and a smaller arc of motion than those with lower BMI. This relationship may have important prognostic implications in the treatment of the obese patient population and patients should be counseled accordingly.


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