Abstract
Aim: Obesity is a very important health problem throughout the
world. The effect of obesity on trauma-related injuries is being investigated in contemporary literature. The weight of the patient
is said to increase complications with the severity of trauma. The
effect of obesity on pelvic trauma has been investigated in various
studies in the literature. However, no similar study investigating
the effect of obesity on acetabular fractures and accompanying
femoral head fractures has been found.
Our aim in this study is to determine the incidence of accompanying femoral head fractures in adult cases with acetabulum fracture and to investigate whether abdominal subcutaneous fat tissue
thickness has an effect on this co-existence.
Material and Method: Pelvic CT scans taken in our hospital due
to trauma were retrospectively reevaluated and cases with acetabulum fracture were detected. These cases were divided into
two separate groups: those with isolated acetabulum fractures and
those with acetabulum-and accompanying femoral head fractures.
Abdominal subcutaneous fat tissue thicknesses of all cases were
measured via CT scan. It has been investigated whether there is a
statistically significant difference between the two groups in terms
of subcutaneous fat tissue thickness.
Results: A total of 95 acetabular fractures were detected. In 22
cases (23.2%), femoral head impaction fracture was present in addition to acetabulum fracture. In the remaining 73 cases (76.8%),
the femur head was normal. The average abdominal subcutaneous fat tissue thickness was 24.4 (±9.2) mm in isolated acetabular
fracture cases, and 30.4 (±8) mm in cases with acetabulum and
accompanying femoral head fractures. Abdominal subcutaneous
fat thickness was significantly higher in patients with femoral head
fracture in addition to acetabulum (p=0.006).
Conclusion: It’s possible to say that abdominal subcutaneous fat
accumulation increases the risk of femoral head fracture development by increasing the severity of trauma, thus increasing the
morbidity.
References
- 1. Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The Cushion Effect. J Trauma 2003;54:1090–3. 2. Backstrom IC, MacLennan PA, Sawyer JR, Creek AT, Rue III LW, Gilbert SR. Pediatric Obesity and Traumatic Lower Extremity Long Bone Fracture Outcomes. J Trauma Acute Care Surg 2012;73:966–71. 3. Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP. Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. J Pediatr. Surg 2009;44:1601–5. 4. Brown CV, Neville AL, Salim A, Rhee P, Cologne K, Demetriades D. The impact of obesity on severely injured children and adolescents. J Pediatr Surg 2006;41:88–91. 5. Brown CVR, 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;59:1048–51. 6. Byard RW, Langlois NE. Letter to the editor-Increasing body weight of motorcycle riders. J Forensic Sci 2011;56:1661. 7. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone 1995;17:505–11. 8. Joakimsen RM, Magnus JH, Fønnebø V. Physical activity and predisposition for hip fractures. a review. Osteoporos Int 1997;7:503–13. 9. Chiron P, Lafontan V, Reina N. Fracture—dislocations of the femoral head. Orthop Trauma Surg Research 2013;99:53–66. 10. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury Int J Care Injured 2007;38:478–88. 11. Beckmann NM, Chinapuvvula NR, Cai C. Association of femoral head and acetabular fractures on computerized tomography: correlation with the Judet-Letournel classification. Emerg Radiol 2017;24:531–9. 12. Kim J, Lim H, Lee SI, Kim YJ. Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index. Arch Plast Surg 2012;39:528–33. 13. Pi-Sunyer FX. The obesity epidemic: pathophysiology and consequences of obesity. Obes Res 2002;10:97–104. 14. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25. 15. Liu HT, Rau CS, Wu SC, Chen YC, Hsu SY, Hsieh HY, et al. Obese motorcycle riders have a different injury pattern and longer hospital length of stay than the normal-weight patients. Scand J Trauma Resusc Emerg Med 2016;24:50. 16. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in bodymass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9 1 million participants. Lancet 2011;377:557–67. 17. Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul health metrics 2012;10:22. 18. Chuang JF, Rau CS, Kuo PJ, Chen YC, Hsu SY, Hsieh HY, et al. Traumatic injuries among adult obese patients in southern Taiwan: a cross-sectional study based on a trauma registry system. BMC Public Health 2016;16:275. 19. Dimitri P, Bishop N, Walsh JS, Eastell R. Obesity is a risk factor for fracture in children but is protective against fracture in adults: A paradox. Bone 2012;50:457–66. 20. Kim SJ, Ahn J, Kim HK, KimJH. Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Pædiatrica 2016;105:1152–7. 21. Davidson PL, Goulding A, Chalmers DJ. Biomechanical analysis of arm fracture in obese boys. J Paediatr Child Health 2003;39:657–64. 22. Pomerantz WJ, Timm NL, Gittelman MA. Injury patterns in obese versus nonobese children presenting to a pediatric emergency department. Pediatrics 2010;125:681–5. 23. Witt CE, Arbabi S, Nathens AB, Vavilala MS, Rivara FP. Obesity in pediatric trauma. J Pediatr Surg 2017;52:628–32. 24. Vaughan N, Tweed J, Greenwell C, Notrica DM, Langlais CS, Peter SD, et al. The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. J Pediatr Surg 2017;52:345–8. 25. Hasanoglu A, Bideci A, Cinaz P, Tumer L, Unal S. Bone mineral density in childhood obesity. J Pediatr Endocrinol Metab 2000;13:307–11. 26. Goulding A, Taylor RW, Jones IE, McAuley KA, Manning PJ, Williams SM. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord 2000;24:627–32. 27. Haricharan RN, Griffin RL, Barnhart DC, Harmon CM, McGwin G. Injury patterns among obese children involved in motor vehicle collisions. J. Pediatr. Surg 2009;44:1218–22. 28. Honkanen RJ, Honkanen K, Kroger H, Alhava E, Tuppurainen M, Saarikoski S. Risk factors for perimenopausal distal forearm fracture. Osteoporos Int 2000;11:265–70. 29. De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: A metaanalysis Osteoporos Int 2005;16:1330–8. 30. Joakimsen RM, Fønnebø V, Magnus JH, Tollan A. Søgaard AJ. The Tromsø Study: Body Height, Body Mass Index and Fractures. Osteoporos Int 1998;8:436–42. 31. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767–73. 32. Gnudi S, Sitta E, Lisi L. Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Metab 2009;27:479–84. 33. Holmberg AH, Johnell O, Nilsson PM, Nilsson J, Berglund G, Akesson K. Risk factors for fragility fracture in middle age. A prospective population-based study of 33, 000 men and women. Osteoporos Int 2006;17:1065–77. 34. Hla MM, Davis JW, Ross PD, Wasnich RD, Yates AJ, Ravn P, et al. Multicenter study of the influence of fat and lean mass on bone mineral content: evidence for differences in their relative influence at major fracture sites. Am J Clin Nutr 1996;64:354–60. 35. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 1994;271:128–33. 36. Morris BJ, Richards JE, Guillamondegui OD, Sweeney KR, Mir HR, Obremskey WT, et al. Obesity Increases Early Complications After High-Energy Pelvic and Acetabular Fractures. Orthopedics 2015;38:881–7. 37. Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC. Obesity Is an Independent Risk Factor of Mortality in Severely Injured Blunt Trauma Patients. Arch Surg 2004;139:983–7. 38. Ryb GE, Dischinger PC. Injury severity and outcome of overweight and obese patients after vehicular trauma: a crash injury research and engineering network (CIREN) study. J Trauma 2008;64:406–11.
Abstract
Amaç: Obezite dünya genelinde çok önemli bir sağlık problemidir.
Güncel literatürde travmalara bağlı hasara obezitenin etkisi araştırılmaktadır. Hasta kilosunun, travmanın şiddeti ile beraber komplikasyonları arttırdığı söylenmektedir. Obez hastalarda travma sonrası ekstremite kırıklarının daha sık görüldüğü öne sürülmektedir. Literatürde
pelvik travmalara obezitenin etkisi çeşitli çalışmalarla araştırılmıştır.
Ancak asetabuler fraktür ve eşlik eden femur başı fraktürlerine obezitenin etkisini araştıran benzer bir çalışma bulunamamıştır.
Bu çalışmada amacımız; asetabulum fraktürü olan erişkin olgularda,
eşlik eden femur başı fraktürünün görülme sıklığını belirlemek ve bu
birlikteliğe abdominal subkutan yağ doku kalınlığının etkisi olup olmadığını araştırmaktır.
Materyal ve Metot: Travma nedeniyle hastanemizde çekilen pelvik
tomografiler retrospektif olarak yeniden değerlendirilerek, asetabulum
fraktürü olan olgular saptandı. Bu olgular, izole asetabulum fraktürü
olanlar ve asetabulum ile femur başı fraktürü birlikte görülenler olarak
iki ayrı gruba ayrıldı. Tüm olguların abdominal subkutan yağ doku kalınlıkları tomografik olarak ölçüldü. İki grup arasında subkutan yağ doku
kalınlığı açısından istatistiksel anlamlı farklılık olup olmadığı araştırıldı.
Bulgular: Toplam 95 olguda asetabuler fraktür bulundu. Olguların
22’sinde (%23,2) femur başı impaksiyon fraktürü eşlik etmekteydi.
Kalan 73 olguda (%76,8) femur başı normaldi. Ortalama abdominal
subkutan yağ doku kalınlığı; izole asetabuler fraktür olan olgularda
24,4 (±9,2) mm, eşlik eden femur başı fraktürü olan olgularda 30,4
(±8) mm idi. Abdominal subkutan yağ doku kalınlığı, femur başı ve
asetabulum fraktürü birlikte görülen olgularda istatistiksel olarak anlamlı derecede daha fazlaydı (p=0,006).
Sonuç: Asetabulum fraktürüne ek olarak femur başı fraktürü izlenen
olgularda abdominal subkutan yağ doku kalınlığı belirgin daha fazla
bulunmuştur. Abdominal subkutan yağ birikiminin, travmanın şiddetini arttırarak femur başı fraktürü gelişimi riskini, dolayısıyla morbiditeyi arttıran bir risk oluşturduğu söylenebilir
References
- 1. Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The Cushion Effect. J Trauma 2003;54:1090–3. 2. Backstrom IC, MacLennan PA, Sawyer JR, Creek AT, Rue III LW, Gilbert SR. Pediatric Obesity and Traumatic Lower Extremity Long Bone Fracture Outcomes. J Trauma Acute Care Surg 2012;73:966–71. 3. Rana AR, Michalsky MP, Teich S, Groner JI, Caniano DA, Schuster DP. Childhood obesity: a risk factor for injuries observed at a level-1 trauma center. J Pediatr. Surg 2009;44:1601–5. 4. Brown CV, Neville AL, Salim A, Rhee P, Cologne K, Demetriades D. The impact of obesity on severely injured children and adolescents. J Pediatr Surg 2006;41:88–91. 5. Brown CVR, 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;59:1048–51. 6. Byard RW, Langlois NE. Letter to the editor-Increasing body weight of motorcycle riders. J Forensic Sci 2011;56:1661. 7. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: Insights afforded by epidemiology. Bone 1995;17:505–11. 8. Joakimsen RM, Magnus JH, Fønnebø V. Physical activity and predisposition for hip fractures. a review. Osteoporos Int 1997;7:503–13. 9. Chiron P, Lafontan V, Reina N. Fracture—dislocations of the femoral head. Orthop Trauma Surg Research 2013;99:53–66. 10. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury Int J Care Injured 2007;38:478–88. 11. Beckmann NM, Chinapuvvula NR, Cai C. Association of femoral head and acetabular fractures on computerized tomography: correlation with the Judet-Letournel classification. Emerg Radiol 2017;24:531–9. 12. Kim J, Lim H, Lee SI, Kim YJ. Thickness of Rectus Abdominis Muscle and Abdominal Subcutaneous Fat Tissue in Adult Women: Correlation with Age, Pregnancy, Laparotomy, and Body Mass Index. Arch Plast Surg 2012;39:528–33. 13. Pi-Sunyer FX. The obesity epidemic: pathophysiology and consequences of obesity. Obes Res 2002;10:97–104. 14. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25. 15. Liu HT, Rau CS, Wu SC, Chen YC, Hsu SY, Hsieh HY, et al. Obese motorcycle riders have a different injury pattern and longer hospital length of stay than the normal-weight patients. Scand J Trauma Resusc Emerg Med 2016;24:50. 16. Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in bodymass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9 1 million participants. Lancet 2011;377:557–67. 17. Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul health metrics 2012;10:22. 18. Chuang JF, Rau CS, Kuo PJ, Chen YC, Hsu SY, Hsieh HY, et al. Traumatic injuries among adult obese patients in southern Taiwan: a cross-sectional study based on a trauma registry system. BMC Public Health 2016;16:275. 19. Dimitri P, Bishop N, Walsh JS, Eastell R. Obesity is a risk factor for fracture in children but is protective against fracture in adults: A paradox. Bone 2012;50:457–66. 20. Kim SJ, Ahn J, Kim HK, KimJH. Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Pædiatrica 2016;105:1152–7. 21. Davidson PL, Goulding A, Chalmers DJ. Biomechanical analysis of arm fracture in obese boys. J Paediatr Child Health 2003;39:657–64. 22. Pomerantz WJ, Timm NL, Gittelman MA. Injury patterns in obese versus nonobese children presenting to a pediatric emergency department. Pediatrics 2010;125:681–5. 23. Witt CE, Arbabi S, Nathens AB, Vavilala MS, Rivara FP. Obesity in pediatric trauma. J Pediatr Surg 2017;52:628–32. 24. Vaughan N, Tweed J, Greenwell C, Notrica DM, Langlais CS, Peter SD, et al. The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center. J Pediatr Surg 2017;52:345–8. 25. Hasanoglu A, Bideci A, Cinaz P, Tumer L, Unal S. Bone mineral density in childhood obesity. J Pediatr Endocrinol Metab 2000;13:307–11. 26. Goulding A, Taylor RW, Jones IE, McAuley KA, Manning PJ, Williams SM. Overweight and obese children have low bone mass and area for their weight. Int J Obes Relat Metab Disord 2000;24:627–32. 27. Haricharan RN, Griffin RL, Barnhart DC, Harmon CM, McGwin G. Injury patterns among obese children involved in motor vehicle collisions. J. Pediatr. Surg 2009;44:1218–22. 28. Honkanen RJ, Honkanen K, Kroger H, Alhava E, Tuppurainen M, Saarikoski S. Risk factors for perimenopausal distal forearm fracture. Osteoporos Int 2000;11:265–70. 29. De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, et al. Body mass index as a predictor of fracture risk: A metaanalysis Osteoporos Int 2005;16:1330–8. 30. Joakimsen RM, Fønnebø V, Magnus JH, Tollan A. Søgaard AJ. The Tromsø Study: Body Height, Body Mass Index and Fractures. Osteoporos Int 1998;8:436–42. 31. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995;332:767–73. 32. Gnudi S, Sitta E, Lisi L. Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Metab 2009;27:479–84. 33. Holmberg AH, Johnell O, Nilsson PM, Nilsson J, Berglund G, Akesson K. Risk factors for fragility fracture in middle age. A prospective population-based study of 33, 000 men and women. Osteoporos Int 2006;17:1065–77. 34. Hla MM, Davis JW, Ross PD, Wasnich RD, Yates AJ, Ravn P, et al. Multicenter study of the influence of fat and lean mass on bone mineral content: evidence for differences in their relative influence at major fracture sites. Am J Clin Nutr 1996;64:354–60. 35. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 1994;271:128–33. 36. Morris BJ, Richards JE, Guillamondegui OD, Sweeney KR, Mir HR, Obremskey WT, et al. Obesity Increases Early Complications After High-Energy Pelvic and Acetabular Fractures. Orthopedics 2015;38:881–7. 37. Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC. Obesity Is an Independent Risk Factor of Mortality in Severely Injured Blunt Trauma Patients. Arch Surg 2004;139:983–7. 38. Ryb GE, Dischinger PC. Injury severity and outcome of overweight and obese patients after vehicular trauma: a crash injury research and engineering network (CIREN) study. J Trauma 2008;64:406–11.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 1, 2018 |
| Published in Issue | Year 2018 |