Do Obesity and Smoking Impact Healing after Wrist Surgery?
Obesity and smoking can have negative effects on bone health. What about in patients who undergo surgery to repair a bone fracture? Do obesity and smoking affect healing in those patients too?
That was the question to be answered in a study of patients with distal radius fractures recently published online by the Journal of Hand Surgery. These fractures account for 5% to 20% of all emergency department fracture visits, with patients who sustain distal radius fractures often experiencing challenges with activities of daily living, as well as potentially serious and costly complications.
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For the study, the investigators retrospectively analyzed data on patients who underwent volar plate fixation for a distal radius fracture between 2006 and 2017 at 2 trauma centers. The 200 patients were divided into obese (n=39) and non-obese (n=161) groups, with obesity defined as a BMI of 30 or more. Patients were also characterized as current smokers (n=20), former smokers (n=32), or never smokers (n=148 patients) based on self-reported cigarette use.
Primary outcomes evaluated by the investigators included:
- Patient-reported outcomes on the Quick Disabilities of the Arm, Shoulder, and Hand form
- Range of motion
- Flexion-extension and pronation-supination
- Fracture union according to the Radiographic Union Scoring System
- Radiographic alignment, including radial height, radial inclination, and volar tilt
At 3 months and 1 year after surgery, the obese and non-obese groups achieved acceptable scores in patient-reported function in the upper extremity, with the scores close to those of the general population. The 2 groups were also similar with regard to range of motion and bone alignment.
Smokers demonstrated worse scores related to arm, shoulder, and hand function and a lower percentage of healed fractures at 3 months after surgery. These differences improved over the course of a year.
“Overall, we found that we can achieve excellent clinical and radiographic outcomes with surgery for displaced wrist fractures in patients who are obese and in those who smoke,” said senior author Tamara D. Rozental, MD, Chief of Hand and Upper Extremity Surgery at Beth Israel Deaconess Medical Center and Professor of Orthopedic Surgery at Harvard Medical School.
“Our results show that treatment for distal radius fractures in obese and smoking patients is safe, and these patients may be treated like the general population with similar long-term results. Their short-term outcomes, however, demonstrate higher disability and, in the case of smokers, slower fracture healing.”
Dr. Rozental stressed that obesity and smoking are currently considered among the 2 most important preventable causes of poor health in developed nations, and both are modifiable risk factors. “As such, we believe that lifestyle interventions focusing on weight loss and smoking cessation should be emphasized whenever possible,” she said.
Save the Date!
FORE’s 6th Annual Frontiers in Upper Extremity Surgery course will be held November 6-7, 2020, in Tampa, Florida, with Michael J. Garcia, MD, and Jason Nydick, DO, once again serving as course chairs. More information will be available next year.
Hall MJ, Ostergaard PJ, Dowlatshahi AS, Harper CM, Earp BE, Rozental TD. The impact of obesity and smoking on outcomes after volar plate fixation of distal radius fractures. J Hand Surg Am. 2019 Oct 30. pii: S0363-5023(19)31362-0. doi: 10.1016/j.jhsa.2019.08.017. [Epub ahead of print].