Evaluating the results of treatment for tibia fractures in overweight patients

Background. Lower limb bone injuries are one of the most severe traumas to the musculoskeletal system. Treatment of lower limb fractures is complicated in overweight and obese patients, in people with diseases of the bones, circulatory system, with diabetes mellitus and other age- and weight-related diseases. Today, four main methods and their modifications are used to treat bone fractures: blocking intramedullary osteosynthesis (BIOS), plate osteosynthesis (PO), external fixation devices (EFD), and plaster casts. The purpose of the study was to evaluate the results of treatment of overweight patients with tibia fractures using BIOS, PO and EFD. Materials and methods. The treatment of 42 patients with tibia fractures aged 21 to 71 years was analyzed. All of them were overweight. The average body mass index was 28.6 ± 1.8, with a range from 25.4 to 33.0. For the treatment of fracture, 27 patients (64.3 %) underwent BIOS, 9 (21.4 %) — PO, and 6 (14.3 %) had EFD. Patients were examined before treatment, after surgery, and at 1.5, 3.5, 6, and 12 months after the start of treatment for the degree of pain; score on the S.D. Tumian questionnaire, data of the system for assessing long-term treatment outcomes, the timing of recovery of the patient’s functional abilities were evaluated as well. Results. Before the surgery, patients rated the pain in the injured limb as severe and very severe (8–10 points). After the surgery, it decreased more, but remained at an average level. According to the analysis, there is a statistically significant (p = 0.001) decrease in pain between the observation periods. After the bone fracture repair, patients in the BIOS group begin to load the limb earlier and reach full weight bearing a month earlier than in the other groups. Evaluating treatment outcomes on the S.D. Tumian questionnaire showed that the tendency to improvement persisted throughout the treatment period in all patients, but the best results were in the BIOS group, which had the highest score already at the 6th month of observation. The assessment of the functional abilities demonstrated that after 12 months, patients in the BIOS and PO groups reported either no pain (77.8 and 55.6 %, respectively) or moderate pain after prolonged walking (22.2 and 33.3 %, respectively), while the EFD group complained of pain after prolonged walking. After 12 months in the BIOS group, the number of patients without claudication was 74.1 %, in the EFD group, people had moderate and not significant claudication. Conclusions. The analysis of outcomes in patients with tibia fractures who were treated using blocking osteosynthesis, periosteal osteosynthesis and external fixation devices showed the feasibility of BIOS in overweight individuals. This makes it possible to start motor activity and the ability to take care of oneself earlier, which is important for such patients.