The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures

被引:24
|
作者
Hall, Matthew J. [1 ]
Ostergaard, Peter J. [1 ]
Dowlatshahi, Arriyan S. [2 ]
Harper, Carl M. [2 ]
Earp, Brandon E. [3 ]
Rozental, Tamara D. [1 ,2 ]
机构
[1] Harvard Combined Orthopaed Residency Program, Boston, MA USA
[2] Beth Israel Deaconess Med Ctr, Div Hand & Upper Extrem Surg, Dept Orthoped, Boston, MA 02215 USA
[3] Harvard Med Sch, Div Hand & Upper Extrem Surg, Dept Orthopaed Surg, Brigham & Womens Hosp, Boston, MA 02115 USA
来源
JOURNAL OF HAND SURGERY-AMERICAN VOLUME | 2019年 / 44卷 / 12期
关键词
Distal radius fracture; patient-reported outcome; obesity; smoking; INCREASED POSTOPERATIVE COMPLICATIONS; DIGITAL BLOOD-FLOW; LOW-PROFILE DORSAL; CIGARETTE-SMOKING; OPERATIVE MANAGEMENT; NICOTINE; DISABILITIES; SEVERITY; SHOULDER; TIBIA;
D O I
10.1016/j.jhsa.2019.08.017
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose Distal radius fractures are common fractures of the upper extremity. Whereas surgical outcomes have been extensively investigated, the impact of risk factors such as body mass index (BMI) and smoking on patient outcomes has not been explored. We hypothesized that obesity and smoking would have a negative impact on the functional and radiographic outcomes of surgically treated patients with distal radius fractures. Methods We performed a retrospective analysis of patients surgically treated for a distal radius fracture between 2006 and 2017 at 2 level 1 trauma centers. Patients were divided into obese (BMI >= 30) and nonobese (BMI < 30) groups according to the World Health Organization BMI Classification. Patients were also divided into current, former, and never smokers based on reported cigarette use. Primary outcomes included patient-reported outcome measures ( Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]), range of motion (ROM) arc (flexion-extension, pronation-supination), radiographic union (Radiographic Union Scoring System [RUSS] score), and change in radiographic alignment (radial height, radial inclination, volar tilt) between first and last follow-up. Multivariable models corrected for age, sex, comorbidities, fracture complexity, osteoporosis, and time to surgery. Results Two hundred patients were identified, 39 with BMI of 30 or greater and 161 with BMI less than 30. Obese patients had more comorbidities but similar fracture types. At 3-month and 1-year follow-up, both groups achieved acceptable QuickDASH scores, close to those of the general population (21 vs 18, 14 vs 2, respectively). The 2 groups were similar in regard to motion, RUSS score, and alignment. There were 148 never smokers, 32 former smokers, and 20 current smokers. At 3 months, smokers demonstrated higher QuickDASH scores (42 vs 21-24) and a lower percentage of radiographically healed fractures (40% vs 69%-82%). At final follow-up, smokers reported small differences in patient-reported outcomes (QuickDASH 18 vs 9-13) whereas ROM, fracture healing, and complication rates were similar. Conclusions Both obese and nonobese patients can achieve excellent outcomes following surgical treatment of distal radius fracture with similar self-reported outcomes, motion, RUSS score, and alignment. Despite slower healing in the early postoperative period, smokers had similar QuickDASH scores, ROM, and union rates to past smokers and never smokers at final follow-up, with a similar complication profile. Copyright (C) 2019 by the American Society for Surgery of the Hand. All rights reserved.
引用
收藏
页码:1037 / 1049
页数:13
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