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Obesity Increases Complexity of Distal Radius Fracture in Fall from Standing Height
Thomas Ebinger, MD; Lori Dolan, PhD; Katelyn McDonald, BS; Brian Adams, MD; Apurva Shah, MD, MBA;
Department of Orthopaedics, University of Iowa, Iowa City, IA

Introduction: Both obesity and fractures of the distal radius are epidemic conditions in the United States. The relationship between these two conditions has not been previously investigated. Our purpose was to investigate the relationship between patient body mass index (BMI) and severity of distal radius fracture. We hypothesized that increased BMI would correlate with increasing severity of distal radius fracture.

Materials & Methods: A retrospective chart review of 423 adult subjects with history of fracture of the distal radius resulting only from a fall from standing height was completed. Demographic data including age at the time of injury, gender, BMI, tobacco use, race, and diabetes was obtained. Wrist radiographs were then reviewed and classified by Arbeitsgemeinschaft für Osteosynthesefragen (AO) group (23-A, 23-B or 23-C). Distal radius fractures were categorized as simple (closed extra-articular (AO group 23-A) without an additional ipsilateral upper extremity fracture) or complex (intra-articular (AO groups 23-B and 23-C) or any open injury or with an additional ipsilateral upper extremity fracture). Descriptive statistics were calculated. Bivariate relationships between the demographic data and the outcome (simple or complex fracture) were evaluated using chi-square and t-tests. Logistic regression was used to model the probability of incurring a complex fracture given risk factors including BMI, age group, and gender.

Results: The average age was 53.8 years of age (range 18-98), with 64% of patients over age 50. Average BMI was 28.0 (range 13.6-59.5). 79% of patients were female. 244 patients (58%) suffered complex distal radius fractures by our criteria. Current smoking status and patient race were not significant predictors of complex injury. Obese patients (BMI > 30) demonstrated an increased risk of suffering a complex injury (p=0.0318). The probability of complex fracture varied based on gender and BMI (Figure 1), and ranged from 38% (female between 18 and 50 years, BMI <20) to 88% (male older than 50 years, BMI >50).

Conclusions: Obesity is clearly associated with more complex fractures of the distal radius, particularly in elderly patients. This relationship has not been previously reported and may have epidemiologic implications in an obese, aging population.

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