Thanksgiving Reminder: Weight Matters After Open Reduction and InternalFixation (ORIF)

In the spirit of Thanksgiving, when many of us add a little extra to our plates, a new study looked at how body mass index (BMI) influences recovery after lower-extremity fracture surgery. Using a 20-year national dataset, adults with BMI ≥30 were compared to those with BMI <30, all followed for two years.

Short-term risks (first 90 days)

Obesity increased complications across the board: 

• Pulmonary embolism: +55%

• Deep vein thrombosis: +30%

• Renal failure: +22%

• Wound disruption: +20%

• Infections: +22% 

Risks rose stepwise with higher BMI. Patients with morbid obesity (BMI ≥50) had triple the risk of pulmonary embolism.

Long-term (two years)

Obesity also predicted more mechanical and healing complications: 

• Post-traumatic arthritis: +61%

• Malunion: +24%

• Nonunion: +29%

• Implant removal: +5%

Severely obese patients (BMI 40–49.9) saw the highest rates of mechanical failure. Interestingly, underweight patients had more early pneumonia but fewer implant removals later.

Takeaway

Like an overfilled Thanksgiving plate, higher BMI adds risk. Obese patients benefit from thorough, stronger pre-op counseling and closer post-op monitoring to improve outcomes.