Injury. 2025 Nov 14;56(12):112891. doi: 10.1016/j.injury.2025.112891. Online ahead of print.

BACKGROUND: This study aimed to compare the effects of obesity and sex on 90-day medical outcomes and two-year outcomes following open reduction and internal fixation (ORIF) of upper extremity fractures.

METHODS: A retrospective analysis was conducted using a nationwide database to identify patients who underwent ORIF of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) between 2003-2023 and had a minimum of 2 year follow-up. Patients were divided into two cohorts based on their BMI: nonobese (BMI<30) and obese (BMI≥30). Further subanalyses were conducted based on BMI categories. Patients were 1:1 propensity score-matched yielding 27,810 patients per group. Primary outcomes included fracture related outcomes at 2 years postoperatively while secondary outcomes were healthcare utilization and medical outcomes at 90 days postoperatively.

RESULTS: At 90 days, obese patients had higher risks of pulmonary embolism (RR 1.57, p = 0.001), deep vein thrombosis (DVT) (RR 1.32, p = 0.011), hospital readmission (RR 1.13, p = 0.042), and wound complications (RR 1.16, p = 0.005), while stroke incidence was lower (RR 0.68, p = 0.034). At 2 years, obese patients had increased risks of malunion/nonunion repair (RR 1.25, p = 0.002), malunion (RR 1.35, p = 0.009), and nonunion (RR 1.18, p = 0.001).

CONCLUSION: Obesity increases 90 day and 2 year complications following upper extremity ORIF. This highlights the need for tailored perioperative management for obese patients undergoing surgical fixation of upper extremity fractures.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort.

PubMed:41273807 | DOI:10.1016/j.injury.2025.112891