Obesity and risk for open reduction and internal fixation of syndesmotic injuries in the setting of concomitant ankle fractures.

INTRODUCTION: The association between obesity and the need for open reduction and surgical fixation of the syndesmosis in the setting of malleolar ankle fractures remains to be elucidated. Therefore, the primary objective of this study was to assess the relationship between obesity, ankle fracture complexity, and the need for open reduction and fixation of the syndesmosis. METHODS: A retrospective analysis of the NSQIP database was performed for patients undergoing surgical fixation of isolated, closed ankle fractures. Patients were grouped by fracture pattern into 6 cohorts (uni-, bi- and trimalleolar ankle fractures with or without syndesmotic injury). Demographic data was collected and compared between groups and logistic regression analyses were used to assess the relationship between body mass index (BMI) and ankle fracture pattern. RESULTS: A total of 15,841 patients (mean age 48.9 years) were identified for inclusion. Regression analyses revealed that BMI had a significant association with the incidence of open reduction and internal fixation of the ankle syndesmosis, but there was no association between BMI and malleolar fracture pattern. CONCLUSIONS: This study demonstrates that elevated BMI is associated with an increased risk for open reduction and internal fixation of the syndesmosis in malleolar ankle fractures. However, obesity was not associated with ankle fracture pattern itself, whereas older age, female sex, and white race were more significant predictors of fracture complexity. This data provides a framework for further evaluation of the effect that both modifiable and non-modifiable risk factors have on fracture complexity and operative management of patients with such injuries. LEVEL OF EVIDENCE: Case-control study. Level III.