Vücut kitle indeksinin pilon kırıklarında radyolojik ve klinik sonuçlar üzerine etkisi

Öz

Amaç: Bu çalışmada amacımız, Vücut Kitle İndeksi’nin (VKİ) pilon kırıklarında klinik ve radyolojik sonuçlara etkisini değerlendirmekti. Bu değerlendirmemizde, VKİ≥30 olarak tanımlanan obez hastaların fonksiyonel ve radyolojik sonuçlarının obez olmayan hastalara göre daha kötü olmayacağını varsaydık.

Çalışma planı: Çalışmaya, Ocak 2008-Mayıs 2011 tarihleri arasında tibia pilon kırığı geçirmiş olan 42 hastanın (33 erkek, 9 kadın; ortalama yaş: 42.67±12.29, dağılım: 18-67), retrospektif olarak incelenen sonuçları dahil edildi. Her hastanın postoperatif komplikasyon insidansı dahil olmak üzere postoperatif seyri ve hastanede kalış süresi tıbbi kayıtlardan belirlendi. Son kontrollerde klinik değerlendirme AOFAS skoruna, radyolojik değerlendirme ise Kellgren-Lawrence sınıflamasına göre yapıldı.

Bulgular: Yirmi dokuz hasta düşük enerjili travmaya, 13 hasta yüksek enerjili travmaya maruz kalmıştı. Ortalama VKİ 28.96±4.86 kg/m² olarak bulundu. Obez hasta sayısı 18, obez olmayan hasta sayısı 24’tü. Son kontrolde ortalama AOFAS skoru 36±20.71 olarak kaydedilirken, hastaların ortalama takip süresi 30.0±11.48 ay idi. Obez grupta yüzeysel enfeksiyon oranı istatistiksel olarak anlamlı derecede yüksek bulundu (p<0.05). Ameliyat süresi ve hastanede kalış süresinin de obez hastalarda istatistiksel olarak anlamlı derecede uzun olduğu saptandı (sırasıyla, p=0.001 ve p=0.041).

Çıkarımlar: Pilon kırığı nedeniyle ameliyat edilen, obez hastalarda klinik ve radyolojik sonuçlar açısından obez olmayan hastalara göre yüzeysel enfeksiyon dışında fark bulunmamıştır. Obez hastalar da, yaranın yakın takibi yapılarak normal kilolu hastalar gibi tedavi edilebilmektedir.

Anahtar Kelimeler

• AOFAS skoru; obez; pilon kırığı; VKİ.

Effect of BMI on the clinical and radiological outcomes of pilon fractures

Öz

Objective: The aim of this study was to evaluate the effect of BMI on clinical and radiological outcomes of pilon fractures. We hypothesized that obese patients, defined as having a BMI of 30 or higher, would not have worse functional and radiological outcome compared to non-obese patients.

Methods: This study retrospectively reviewed 42 patients (33 males and 9 females; mean age: 42.67±12.29 years, range: 18 to 67 years) who sustained tibial pilon fractures between January 2008 and May 2011. Each patient’s postoperative course, including the incidence of postoperative complications, and the length of hospital stay was determined from medical charts. At the final follow-up, clinical assessment was made according to the AOFAS score and radiological evaluation was made according to the Kellgren-Lawrence classification.

Results: Twenty-nine patients had low-energy trauma, while 13 had high-energy trauma. Mean BMI was 28.96±4.86 kg/m2. There were 18 obese patients and 24 non-obese patients. Mean AOFAS score at the final follow-up was 68.36±20.71. The average follow-up time was 30.0±11.48 months. Superficial infection in the obese group occurred at a statistically significantly higher rate (p<0.05). Operation and hospitalization times occurred at a significantly higher rate in the obese group (p=0.001 and p= 0.041, respectively).

Conclusion: Body mass index does not affect the clinical and radiological outcomes of tibial pilon fractures, with the exception of superficial infection. Obese patients could be treated as non-obese patients with close monitoring of the wound.

Anahtar Kelimeler

• AOFAS score
• BMI
• obese
• pilon fracture

Kaynakça

1. Calori GM, Tagliabue L, Mazza E, de Bellis U, Pieran- nunzii L, Marelli BM, et al. Tibial pilon fractures: which method of treatment? Injury 2010;41:1183-90. CrossRef
2. Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg 2011;19:612-22.
3. Kalenderer O, Güneş O, Ozçalabi IT, Ozlük S. [Clini- cal results of tibial pilon fractures treated by open reduc- tion and internal fixation]. Acta Orthop Traumatol Turc 2003;37:133-7.
4. Abidi NA, Dhawan S, Gruen GS, Vogt MT, Conti SF. Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 1998;19:856-61. CrossRef
5. Parratte S, Pesenti S, Argenson JN. Obesity in ortho- pedics and trauma surgery. Orthop Traumatol Surg Res 2014;100(1 Suppl):91-7. CrossRef
6. Richmond SA, Fukuchi RK, Ezzat A, Schneider K, Schneider G, Emery CA. Are joint injury, sport activity, physical activity, obesity, or occupational activities pre- dictors for osteoarthritis? A systematic review. J Orthop Sports Phys Ther 2013;43:515-B19. CrossRef
7. Dodson NB, Ross AJ, Mendicino RW, Catanzariti AR. Factors affecting healing of ankle fractures. J Foot Ankle Surg 2013;52:2-5. CrossRef
8. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classifi- cation. J Orthop Trauma 1996;10 Suppl 1:v-ix, 1-154.

9. Grose A, Gardner MJ, Hettrich C, Fishman F, Lorich DG, Asprinio DE, et al. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma 2007;21:530-7. CrossRef
10. Zou J, Zhang W, Zhang CQ. Comparison of minimally invasive percutaneous plate osteosynthesis with open re- duction and internal fixation for treatment of extra-articu- lar distal tibia fractures. Injury 2013;44:1102-6. CrossRef
11. Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg 2011;77:432-40.
12. White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP, Bla- chut PA, et al. The results of early primary open reduc- tion and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study. J Orthop Trauma 2010;24:757-63.
13. Li Y, Liu L, Tang X, Pei F, Wang G, Fang Y, et al. Compari- son of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop 2012;36:1457-62. CrossRef
14. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494-502. CrossRef
15. Strauss EJ, Frank JB, Walsh M, Koval KJ, Egol KA. Does obesity influence the outcome after the operative treatment of ankle fractures? J Bone Joint Surg Br 2007;89:794-8.
16. Compston JE, Flahive J, Hosmer DW, Watts NB, Siris ES, Silverman S, et al. Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res 2014;29:487-93. CrossRef
17. Wilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. Adv Skin Wound Care 2004;17:426-35.
18. Karunakar MA, Shah SN, Jerabek S. Body mass index as a predictor of complications after operative treatment of ace- tabular fractures. J Bone Joint Surg Am 2005;87:1498-502.
19. Everhart JS, Altneu E, Calhoun JH. Medical comorbidi- ties are independent preoperative risk factors for surgical infection after total joint arthroplasty. Clin Orthop Relat Res 2013;471:3112-9. CrossRef
20. Graves ML, Porter SE, Fagan BC, Brien GA, Lewis MW, Biggers MD, et al. Is obesity protective against wound heal- ing complications in pilon surgery? Soft tissue envelope and pilon fractures in the obese. Orthopedics 2010;33.
21. Amri R, Bordeianou LG, Sylla P, Berger DL. Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery. Am J Surg 2014;207:17-23. CrossRef
22. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treat- ment of complex pilon fractures. J Orthop Trauma 1999;13:78-84. CrossRef
23. Böstman OM. Body-weight related to loss of reduction of fractures of the distal tibia and ankle. J Bone Joint Surg Br 1995;77:101-3.
24. Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 2007;21:355-61. CrossRef
25. Thordarson DB. Complications after treatment of tibial pilon fractures: prevention and management strategies. J Am Acad Orthop Surg 2000;8:253-65.
26. Leonard M, Magill P, Khayyat G. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia. Int Orthop 2009;33:1149-53. CrossRef
27. Etter C, Ganz R. Long-term results of tibial plafond frac- tures treated with open reduction and internal fixation. Arch Orthop Trauma Surg 1991;110:277-83. CrossRef