Elevated body mass index is associated with tibial plateau fracture complexity and post-operative complications

Abstract

Introduction As the average body mass index (BMI) is increasing at an alarming rate, dichotomous literature exists regarding whether BMI is protective or disadvantageous for fracture risk. Therefore, the purpose of this study was to evaluate the relationship between BMI, fracture complexity, and post-operative complications for tibial plateau fractures. Methods A retrospective analysis of the National Surgical Quality Improvement Program’s database for the years 2005–2018 was completed. Only patients undergoing primary surgical fixation of an isolated tibial plateau fracture were included. Patients were then stratified into unicondylar and bicondylar fracture patterns by CPT code. Multivariate logistic regression analyses were used to assess risk factors for fracture severity, post-operative complications, and staged fixation. Results Of the 3454 patients identified for inclusion, we found that patients with higher BMIs were more likely to sustain a bicondylar fracture compared with patients with lower BMIs. For each additional BMI point, the risk of sustaining a bicondylar fracture increased by 1.0%. Additionally, there was a 3.8% increased risk of surgical complications for every increased BMI point. Specifically, the risk of a deep infection increased by 6.1%, wound dehiscence by 8.5%, and venous thromboembolism by 4.2%. Conclusion This data demonstrates that an elevated BMI is associated with increased tibial plateau fracture complexity and post-operative complications. These results may be used to help surgeons and hospitals identify at-risk patients to help guide perioperative management in an effort to help mitigate such complications as much as possible.