Introduction: The rising prevalence of obesity poses major challenges in the perioperative management of patients undergoing orthopaedic procedures, particularly proximal femur fracture fixation. Obese individuals frequently present with multiple comorbidities and altered physiology that influence every phase of surgical care. This review aims to identify these challenges and outline practical strategies to optimise perioperative outcomes. Methods: A comprehensive literature review was performed using Medline, PubMed, EMBASE, Cochrane Library, and ProQuest databases. Search terms included obese , proximal femur fracture , intertrochanteric fracture , perioperative complications , surgical challenges , and postoperative outcomes . Articles published up to 30 January 2025 were analysed, including discussions on the ‘obesity paradox’ and its clinical implications. Results: Preoperative challenges include a higher incidence of obstructive sleep apnoea, pulmonary hypertension, and left ventricular dysfunction. Altered pharmacokinetics necessitate weight-adjusted anaesthetic dosing—benzodiazepines by total body weight and opioids by ideal body weight. Intraoperatively, large panniculus and excessive soft tissue complicate positioning and exposure, requiring specialised tables, taping techniques, and modified instrumentation. Postoperatively, increased risks of wound dehiscence, thromboembolism, delayed mobilisation, and respiratory compromise demand layered closures, early physiotherapy, and CPAP/BiPAP support. Interestingly, the ‘obesity paradox’ suggests that selected obese patients may exhibit favourable survival, warranting individualised care. Conclusion: Management of proximal femur fractures in obese patients mandates a multidisciplinary, individualised approach. Optimising comorbidities, meticulous intraoperative planning, and proactive postoperative protocols are key to minimising complications and improving outcomes in this complex population.
Singla et al. (Sun,) studied this question.