Impact of obesity on reduction quality and operative outcomes of proximal femoral nail for intertrochanteric femoral fractures in the lateral decubitus position
- 1Department of Orthopaedics and Traumatology, Giresun University, Giresun, Turkey
- 2Department of Orthopaedics and Traumatology, Arhavi State Hospital, Artvin, Turkey
Abstract
Background: The aim of this study is to compare the clinical and radiological outcomes of proximal femoral nailing performed in the lateral decubitus position between obese and non-obese patients.
Methods: This retrospective cohort study, approved by the institutional ethics committee, included patients with acute AO/OTA classification types 31A1, 31A2, and 31A3 intertrochanteric femoral fractures treated with closed reduction and osteosynthesis using a short proximal femoral nail between 2022 and 2024. Obesity was defined as a body mass index of ≥ 30 kg/m2. Patients were divided into obese and non-obese groups, and clinical, radiological, and complication outcomes were compared between the two groups.
Results: A total of 533 patients were included, comprising 95 obese and 438 non-obese individuals. Obese patients were significantly younger and had higher Charlson Comorbidity Index scores (p < 0.001). Operative time and intensive care unit admission rates were significantly higher in the obese group (p < 0.001), and anesthesia type distribution differed between groups (p < 0.001). Length of hospital stay and Harris Hip Scores were comparable (p > 0.05). Radiologically, the distribution of tip–apex distance according to the 25-mm threshold did not differ between groups (p = 0.244). However, optimal screw placement according to the Cleveland index was significantly less frequent in obese patients (p < 0.001), and malposition in the lateral view was more common (p < 0.001). Varus alignment and differences in reduction quality were also significantly associated with obesity status (p < 0.001). Multivariable logistic regression analysis demonstrated that obesity remained an independent predictor of postoperative varus malalignment (OR 2.80, 95% CI 1.58–4.96; p < 0.001).
Conclusion: Obesity negatively affects reduction quality and operative parameters during proximal femoral nailing for intertrochanteric femoral fractures performed in the lateral decubitus position, although acceptable reductions can generally still be achieved. Furthermore, obesity remained an independent predictor of postoperative varus malalignment after adjustment for potential confounding factors. Surgeons should be aware of these technical challenges when treating obese patients and consider them during preoperative planning and intraoperative reduction maneuvers.
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BibTeX
@article{teksan2026impact,
title = {{Impact of obesity on reduction quality and operative outcomes of proximal femoral nail for intertrochanteric femoral fractures in the lateral decubitus position}},
author = {Emre Teksan and Halil Karaca},
journal = {Journal of Orthopaedic Surgery and Research},
year = {2026},
month = oct,
doi = {10.1186/s13018-026-07301-5},
url = {https://doi.org/10.1186/s13018-026-07301-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of obesity on reduction quality and operative outcomes of proximal femoral nail for intertrochanteric femoral fractures in the lateral decubitus position
AU - Emre Teksan
AU - Halil Karaca
PY - 2026
DA - 2026/10/07
JO - Journal of Orthopaedic Surgery and Research
DO - 10.1186/s13018-026-07301-5
UR - https://doi.org/10.1186/s13018-026-07301-5
AB - Background: The aim of this study is to compare the clinical and radiological outcomes of proximal femoral nailing performed in the lateral decubitus position between obese and non-obese patients. Methods: This retrospective cohort study, approved by the institutional ethics committee, included patients with acute AO/OTA classification types 31A1, 31A2, and 31A3 intertrochanteric femoral fractures treated with closed reduction and osteosynthesis using a short proximal femoral nail between 2022 and 2024. Obesity was defined as a body mass index of ≥ 30 kg/m2. Patients were divided into obese and non-obese groups, and clinical, radiological, and complication outcomes were compared between the two groups. Results: A total of 533 patients were included, comprising 95 obese and 438 non-obese individuals. Obese patients were significantly younger and had higher Charlson Comorbidity Index scores (p < 0.001). Operative time and intensive care unit admission rates were significantly higher in the obese group (p < 0.001), and anesthesia type distribution differed between groups (p < 0.001). Length of hospital stay and Harris Hip Scores were comparable (p > 0.05). Radiologically, the distribution of tip–apex distance according to the 25-mm threshold did not differ between groups (p = 0.244). However, optimal screw placement according to the Cleveland index was significantly less frequent in obese patients (p < 0.001), and malposition in the lateral view was more common (p < 0.001). Varus alignment and differences in reduction quality were also significantly associated with obesity status (p < 0.001). Multivariable logistic regression analysis demonstrated that obesity remained an independent predictor of postoperative varus malalignment (OR 2.80, 95% CI 1.58–4.96; p < 0.001). Conclusion: Obesity negatively affects reduction quality and operative parameters during proximal femoral nailing for intertrochanteric femoral fractures performed in the lateral decubitus position, although acceptable reductions can generally still be achieved. Furthermore, obesity remained an independent predictor of postoperative varus malalignment after adjustment for potential confounding factors. Surgeons should be aware of these technical challenges when treating obese patients and consider them during preoperative planning and intraoperative reduction maneuvers.
SN - 1749-799X
ER -