Ankle fracture severity linked to obesity

By Lynda Williams

Obese patients experience more severe ankle fractures than individuals with a healthy body mass index (BMI), research suggests.

The study findings, published in the Journal of Foot and Ankle Surgery, show that patients with a BMI of 30 kg/m² or above were almost twice as likely to have a Weber C fracture than type A or B fractures.

Patients with Weber C fractures are routinely recommended for surgery and their fracture usually disrupts the tibiofibular syndesmosis, causing instability, explain Christy King (Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, California, USA) and co-authors.

By contrast, Weber A fractures only require surgery if there is medial injury, and type B fractures are operated on if there are also complex bimalleolar, trimalleolar, or bimalleolar equivalent fractures, they say.

The researchers reviewed radiographs from 280 patients (180 female), aged an average of 52 years, with ankle fractures, and collated information on the patients' Weber classification, BMI, gender, age, diabetes, tobacco use, and osteoporosis.

Half (51.4%) the patients had a BMI of 30 kg/m², 21% of patients had Weber A fractures, 59% had B fractures, and 20% had C fractures. But obese patients accounted for 46% of Weber A, 50% of Weber B fractures, and 61% of Weber C fractures.

In multivariate analysis, the odds ratio (OR) for Weber C versus A and B fractures was 1.78 for obese patients. The risk for Weber C fractures was also significantly predicted by age less than 25 years (OR=3.97) and male gender (OR=1.74).

The likelihood of Weber C fractures was not influenced, however, by osteoporosis, tobacco use, or bone mineral density.

Noting that previous research has indicated overweight or obese patients may have a more complicated recovery than those with a healthy weight, King et al conclude: "It is important to recognize the potential risks of obesity, including the possibility of a more severe ankle fracture, to help manage the injury in all phases of treatment."

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