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Obesity Surgery

, Volume 18, Issue 6, pp 702–708 | Cite as

Operative Experience of Pelvic Fractures in the Obese

  • Scott E. Porter
  • Matt L. Graves
  • Zhen Qin
  • George V. Russell
Research Article

Abstract

Background

Disruptions of the pelvic ring may be a significant short- or long-term source of morbidity and mortality. In the obese, temporary stabilization and definitive fixation of the injured pelvis is a much more difficult undertaking, requiring more surgeon expertise and larger surgical approaches. Complications that arise as a result of the operative fixation of pelvic ring injuries may significantly minimize any potential long-term benefits conferred by attempts at fixation.

Methods

During a continuous 46-month period, 288 patients with pelvic ring injuries were prospectively enrolled into a database. A cohort of 186 nonobese patients (group 1) was compared to the cohort of 102 obese patients (group 2). Injury patterns were classified and outcome variables were grouped into perioperative variables, perioperative complications, and late complications.

Results

Injury patterns differed significantly between the two groups. There was an increase in the perioperative variables. Overall, there were complications in 19% of nonobese patients and 39% of obese patients (p < 0.001). Wound complications dominated in the obese group. There were 64 additional surgeries in 30 (16%) patients that were the direct result of complications in group 1 and 62 additional surgeries in 31 (31%) patients in group 2.

Conclusions

In the obese, the time commitment, postoperative complication rate, and subsequent surgery rate are significantly greater. In this patient population, special attention should be focused on operative and soft tissue techniques in an effort to lessen the infection risk, the most likely cause of morbidity.

Keywords

Pelvic bones Pelvis Trauma Obesity Morbid obesity Intraoperative complication Peroperative complication Postoperative complication 

References

  1. 1.
    CDC. Overweight and obesity. www.cdc.gov/nccdphp/dnpa/obesity/. Accessed 24 April 2007
  2. 2.
    Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci. 2006;331(4):166–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Guss D, Bhattacharyya T. Perioperative management of the obese orthopaedic patient. J Am Acad Orthop Surg. 2006;14(7):425–32.PubMedGoogle Scholar
  4. 4.
    Byrnes MC, McDaniel MD, Moore MB, Helmer SD, Smith RS. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7.PubMedGoogle Scholar
  5. 5.
    Brown CV, Neville AL, Rhee P, Salim A, Velmahos GC, Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59(5):1048–51; discussion 1051.PubMedGoogle Scholar
  6. 6.
    Choban PS, Weireter LJ, Maynes C. Obesity and increased mortality in blunt trauma. J Trauma. 1991;31(9):1253–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Harris I, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58(4):778–82.PubMedGoogle Scholar
  8. 8.
    Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma. 1989;29:981–1000.PubMedGoogle Scholar
  9. 9.
    Ertel WK. General assessment and management of the polytrauma patient. In: Tile M, Helfet DL, Kellam JF, editors. Fractures of the pelvis and acetabulum. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 61–79.Google Scholar
  10. 10.
    Demetriades D, Karaiskakis M, Toutouzas K, Alo K, Velmahos G, Chan L. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10.PubMedCrossRefGoogle Scholar
  11. 11.
    Pattimore D, Thomas P, Dave SH. Torso injury patterns and mechanisms in car crashes: an additional diagnostic tool. Injury. 1992;23:123–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Archdeacon MT, Hiratzka J. The trochanteric C-clamp for provisional pelvic stability. [Case reports. Journal article.] J Orthop Trauma. 2006;20(1):47–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Poelstra KA, Kahler DM. Supra-acetabular placement of external fixator pins: a safe and expedient method of providing the injured pelvis with stability. [Case reports. Journal article.] Am J Orthop 2005;34(3):148–51.PubMedGoogle Scholar
  14. 14.
    McCarthy ML, MacKenzie EJ, Bosse MJ, Copeland CE, Hash CS, Burgess AR. Functional status following orthopedic trauma in young women. J Trauma. 1995;39(5):828–36; discussion 836–7.PubMedGoogle Scholar
  15. 15.
    Brenneman FD, Katyal D, Boulanger BR, Tile M, Redelmeier DA. Long-term outcomes in open pelvic fractures. J Trauma. 1997;42(5):773–7.PubMedGoogle Scholar
  16. 16.
    Tornetta P III, Templeman DC. Expected outcomes after pelvic ring injury. [Review] [29 refs] [Journal article. Review.] Instr Course Lect. 2005;54:401–7.PubMedGoogle Scholar
  17. 17.
    Kabak S, Halici M, Tuncel M, Avsarogullari L, Baktir A, Basturk M. Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma. 2003;17(8):555–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop. 1980;151:12–21.PubMedGoogle Scholar
  19. 19.
    Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445–51.PubMedGoogle Scholar
  20. 20.
    Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma. 2003;54(6):1090–3.PubMedGoogle Scholar
  21. 21.
    McKee MD, Waddell JP. Intramedullary nailing of femoral fractures in morbidly obese patients. J Trauma. 1994;36(2):208–10.PubMedCrossRefGoogle Scholar
  22. 22.
    The obesity epidemic. Plast Reconstr Surg. 2006;117 Suppl 1:5–7S; discussion 82–3S.Google Scholar
  23. 23.
    Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop. 1993;289:175–9.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Scott E. Porter
    • 1
  • Matt L. Graves
    • 1
  • Zhen Qin
    • 1
  • George V. Russell
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Mississippi Medical CenterJacksonUSA

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