SLR - November 2022 - Yousef Nafal, DPM
Title: The effect of BMI on long-term outcomes after operatively treated ankle fractures: a study with up to 16 years of follow-upReference: Cardoso DV, Paccaud J, Dubois-Ferrière V, Barea C, Hannouche D, Veljkovic A, Lübbeke A. The effect of BMI on long-term outcomes after operatively treated ankle fractures: a study with up to 16 years of follow-up. BMC Musculoskelet Disord. 2022 Apr 4;23(1):317. doi: 10.1186/s12891-022-05247-3. PMID: 35379212; PMCID: PMC8978374.
Level of Evidence: III
Reviewed by: Yousef Nafal, DPM
Residency program: Beaumont Wayne Hospital, Wayne, MI
Podiatric Relevance: Ankle fractures remain one of the most common traumas accounting for approximately 10% of all fractures. Most often these fractures are treated surgically due to the nature of the injury and their relative instability. Often the preferred surgical treatment consists of open reduction and internal fixation. The most common complication associated with surgical intervention involves post-traumatic ankle arthritis. The prevalence of obesity is increasing worldwide and this population is known to have poorer outcomes after ankle fractures. The purpose of this research was to assess the long-term outcome in patients treat surgically after sustaining an ankle fracture and the effect of BMI by using patient reported outcome questionnaire. Their objective was to assess long‐term patient‐reported outcomes in patients with operatively treated ankle.
Methods: The authors of the study performed a retrospective review of ankle fracture treated from 2002-2012. A patient-reported outcome questionnaire (the Manchester Oxford foot and ankle questionnaire) was used to acquire information post-surgical intervention. The mean average follow-up after surgery was 11.1 years.
Results: The authors of the study looked at a total of 2055 ankle fractures of which, 478 completed the questionnaire. Of the 478 patients, 47% were of normal BMI, 36% were overweight and 17% were considered obese. In terms of the fracture pattern, Weber A, B or C had no statistical difference in the pattern of fracture and the BMI groups. However, when the authors of the study compared obese versus non-obese patients, there was a large difference in the patient-reported outcome and functional scores. The results demonstrated that patients with an elevated BMI had a greater pain score following surgical intervention. Additionally, difference in BMI did not correlate to increased risks of complications or re-operation rates.
Conclusions: Based on the findings of the authors of the study, they determined that patients with elevated BMI had significant worse long-term outcome which includes increased pain, poorer functions and greater impairment of activities of daily living when compared to patients who had a normal BMI. What the authors determined with their research was that pain and function were directly proportional to BMI. However, based on these findings, my opinion on the subject hand is that although BMI is increasing worldwide, if a patient suffers an ankle fracture which requires surgical intervention, it is our obligation and duty to surgically intervene for the best patient outcome. BMI should not be used as a variable to not surgically intervene.