Samuel John Jebasingam Issace1, Rashdeep Singh Jagdeb Singh2, Narresh Sisubalasingam3, Mehmet Ali Tokgöz4, Ashish Jaiman5, Sanjiv Rampal6

1Department of Orthopaedics and Traumatology, Hospital Pengajar, University Putra Malaysia, Selangor, Malaysia
2Department of Orthopaedics and Traumatology, Miri General Hospital, Sarawak, Malaysia
3Department of Health Services, Malaysian Armed Forces Health Services, Kuala Lumpur, Malaysia
4Department of Orthopaedics and Traumatology, Medicine Faculty of Gazi University, Ankara, Türkiye
5Vardhman Mahavir Medical College and Safdarjung Hospital, Central Institute of Orthopaedics, New Delhi, India
6Department of Orthopaedics and Traumatology, Faculty of Medical and Health Sciences, University Putra Malaysia, Selangor, Malaysia

Keywords: Femur fracture, fracture healing, intramedullary locking nail, obesity.


Objectives: This study aims to evaluate the effect of obesity on radiological fracture union in diaphyseal femoral fractures (DFFs) treated with intramedullary nailing (IMN).

Patients and methods: Between January 2017 and December 2018, a total of 120 patients (101 males, 19 females; mean age: 35.1±3.0 years; range, 18 to 72 years) treated with IMN for closed DFFs were retrospectively analyzed. Data including age, sex, location, weight, height, comorbidities such as diabetes mellitus, hypertension or kidney injury, date of injury, mechanism of injury, type of femoral fractures (AO classification), date of surgery, duration of surgery, IMN length and diameter used, date of radiological fracture union and complications of surgery such as nonunion, delayed union, and infections were recorded.

Results: Of the patients, 63 had obesity and 57 did not have obesity. There was a statistically significant difference in fracture configuration among patients with obesity; they sustained type B (p=0.001) and type C (p=0.024), the most severe fracture configuration. The nonunion rate was 45%. Obesity had a significant relationship with fracture nonunion with patients with obesity having the highest number of nonunion rates (n=40, 74.1%) compared to those without obesity (n=14, 25.9%) (p=0.001). Fracture union was observed within the first 180 days in 78.9% of patients without obesity, while it developed in the same time interval in only 38.1% of patients with obesity (p=0.001).

Conclusion: Fracture union time for the patients with obesity was longer, regardless of the fracture configuration. Obesity strongly affects fracture union time in DFFs treated with an IMN. Obesity should be considered a relative risk in decisionmaking in the choice of fixation while treating midshaft femoral fractures.

Citation: Issace SJJ, Singh RSJ, Sisubalasingam N, Tokgöz MA, Jaiman A, Rampal S. Does obesity affect diaphyseal femoral fracture healing treated with intramedullary locking nail?. Jt Dis Relat Surg 2023;34(1):9-15. doi: 10.52312/jdrs.2023.649

Ethics Committee Approval

The study protocol was approved by the Medical Research and Ethics Committee (date: 10.07.2019, no: NMRR-19-1317-48054 [IIR]). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept and design: S.R., N.S.; Data collection and/or processing: S.J.I., N.S., R.S.; Analysis and/or interpretation and control/supervision: S.R., N.S., M.A.T.; Literature review: S.J.I., N.S., M.A.T.; Writing the article: All authors; Critical review: S.R., A.J., M.A.T., N.S.; References and fundings: R.S., M.A.T., S.J.I.; Materials: S.J.I., R.S., N.S.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.