Key result
Chronic heart disease, immobility, malnutrition, and injury severity linked to more complications after lower-limb fracture surgery.
Why the study?
Postoperative outcomes following surgical treatment of lower-extremity fractures may be influenced by pre-existing comorbidities and injury severity, leading the authors to investigate whether internal and external factors associate with postoperative complication rates.
What internal and external factors are associated with postoperative complication rates in patients undergoing surgical treatment for traumatic lower-extremity fractures?
Cohort (n=416)
No
What internal and external factors are associated with postoperative complication rates in patients undergoing surgical treatment for traumatic lower-extremity fractures?
In patients with lower-extremity fractures, injury severity, immobility, malnutrition, and pre-existing heart failure are significant predictors of postoperative complications.
May aid preoperative risk stratification; hypothesis-generating and requires prospective validation before guiding interventions.
Background and Purpose: Surgical treatment of lower-extremity fractures can result in postoperative complications. Irrespective of specific surgical procedures, postoperative outcomes may be influenced by pre-existing comorbidities, as well as by the severity of the injury. This study investigates whether (I) internal factors and (II) external factors are associated with (III) postoperative complication rates. Material and Methods: A prospective study was conducted at a Level I trauma center between 2014 and 2018. A cohort of 416 patients with surgical treatment after traumatic long bone fractures of the lower extremities was assessed, with comorbidities along with factors such as age, malnutrition, and impaired mobility systematically evaluated. Injury severity was classified using the Abbreviated Injury Scale; fracture type and location using the AO/OTA classification; and postoperative complications using the Clavien–Dindo system. Results: Across the cohort, internal factors such as immobility and malnutrition were associated with an increased complication rate. Age showed a weak correlation. Obesity demonstrated a trend toward a protective effect. Patients with femoral fractures exhibited a higher prevalence of cardiovascular comorbidities, with heart failure representing the most pronounced risk factor. In the subgroup with lower leg fractures, chronic heart disease also remained a significant predictor of complications. Correlation analysis further revealed a significant positive association between injury severity and the occurrence of complications across the overall cohort. Conclusions: This study provides valuable insights into risk factors for complicated postoperative courses. Injury severity appears to be a promising predictor of complication risk in patients with leg fractures. Reduced mobility and malnutrition, likewise, were significantly associated with increased complication rates; these may represent the most readily addressable modifiable risk factors. All data were collected using validated, user-friendly classification systems that may be suitable for predictive modeling.
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Erne et al. (2025) conducted a cohort in Traumatic long bone fractures of the lower extremities (n=416). Internal and external risk factors (e.g., immobility, malnutrition, injury severity) was evaluated on Postoperative complications (assessed using the Clavien-Dindo system). Immobility, malnutrition, injury severity, and chronic heart disease were significantly associated with increased postoperative complication rates following lower-extremity fracture surgery.
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