Body Mass Index and Outcomes After Pilon Fracture Fixation: A Retrospective Cohort Study
Background: Pilon fractures of the distal tibial plafond account for 1% to 10% of all tibial fractures and are often associated with serious complications. As body mass index (BMI) is known to impact post-operative outcomes, particularly infection and nonunion, after trauma, the goal of this study is to explore these trends after pilon fractures. Methods: A single-center retrospective review of patients undergoing surgical fixation for pilon fractures between January 2013 and June 2023 was conducted. Only patients with at least a 6-month follow-up period were included. Demographic data and injury characteristics were extracted. Post-operative outcomes and complications were computed. Bivariate analysis via t test were applied, followed by multivariate analysis using primary and reduced models to evaluate for poor outcomes. Various BMI cutoffs (≥30, ≥35, ≥40, ≥45) were also employed to evaluate the relationship between outcomes and various obesity categories. Nonunion was assessed at ≥6 months postoperatively. Results: There were 132 patients included. There was no significant relationship between BMI and infection rates, nonunion rates, and development of post-traumatic osteoarthritis (PTOA) on bivariate analysis (P > .05). On multivariate analysis, diabetes mellitus was a risk factor for infection (P = .01), but BMI was not predictive of any outcomes in the primary or reduced models (P > .05). There were no significant differences in infection, nonunion, and PTOA rates when employing various BMI cutoffs (P > .05). Discussion: BMI was not found to be an independent predictor of post-operative complications in patients with pilon fractures in this cohort. Our study suggests that pilon fractures are unique and counter historic lower-extremity injury postoperative care protocols that consider weight, although further investigation in larger cohorts with long-term follow-up is required to define this trend. Level of Evidence: Level III, retrospective cohort series.
