October 2012

Are Obese Patients More Prone To Ankle Fractures?

By Brian McCurdy, Senior Editor

As the American population trends toward becoming more overweight and obese, such patients may have a greater risk for musculoskeletal problems such as ankle fractures. A recent study in the Journal of Foot and Ankle Surgery concludes that obese patients have a higher risk of sustaining a more proximal distal fibula fracture.

   Researchers performed a retrospective review of radiographs of 280 patients with ankle fractures using the Weber classification. Authors found a body mass index of 30 kg/m2 or greater in 45 percent of patients with Weber A fractures, in 50 percent of patients with Weber B fractures and in 60 percent of patients with Weber C fractures. The results did not demonstrate that diabetes mellitus, osteoporosis/osteopenia and current tobacco use had any significant association with the severity of the ankle fracture.

   Neither Christopher Hyer, DPM, nor Patrick DeHeer, DPM, have seen obesity as an independent or significant risk factor for ankle fractures.

   However, Dr. Hyer does note that as more of the population is becoming obese, physicians are more likely to see people with ankle fractures who are obese. He adds that with more weight, there is more force involved during the injury, which may make fracture more likely. Dr. Hyer says the strength of the bone is among the other factors that relates to the risk of fracture.

   Will ankle fractures become more common with the rise in obesity? “I think obese patients are less active than non-obese patients and oftentimes these types of injuries are activity-related such as basketball injuries, so for activity-related injuries, I do not see a correlation,” says Dr. DeHeer, a Fellow of the American College of Foot and Ankle Surgeons, who practices at Hoosier Foot and Ankle in Carmel, Ind. He notes that obese patients are more prone to injuries due to slips and falls, such as ice-related injuries.

   For obese patients with ankle fractures, the biggest challenge is medical management, according to Dr. Hyer, the Director of the Advanced Reconstructive Foot and Ankle Fellowship at the Orthopedic Foot and Ankle Center in Westerville, Ohio. As he notes, obese patients have difficulty adhering with non-weightbearing during the healing phase and are also at greater risk for postoperative deep vein thrombosis and other medical complications.

   Dr. DeHeer notes that surgical correction can be more difficult in obese patients due to the presence of more adipose tissue to dissect through. He says the obese patient’s bone is often more osteoporotic, and such patients tend to have edema in their lower extremities to begin with, which makes wound complications more likely.

Antimicrobial Therapy And Early Surgical Debridement: A Good Combination For Limb Salvage?

By Danielle Chicano, Editorial Associate

Given the high rate of major amputation in patients with diabetic foot osteomyelitis, a new study concludes that limited amputation plus antimicrobial therapy is an effective method for achieving clinical cure and limb salvage in patients with diabetic foot osteomyelitis.

   The two-year retrospective cohort study, which was recently published in the Journal of the American Podiatric Medical Association, tracked 50 patients with diabetic foot osteomyelitis. Researchers administered broad-spectrum empirical antimicrobial therapy tailored to microbiologic culture data for most patients. After a median follow-up of 26 months, study authors noted that 32 patients were cured. Out of the 18 patients who failed initial therapy, 15 underwent limb-sparing surgery. Only three patients required a below-the-knee amputation.

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