Evidence map›Paper›PMID 41843213›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026

Body mass index, not local adiposity, best predicts surgical site infection following surgical fixation of distal femur fractures.

Brian D Rust, Daniel E Pereira, David W Barton, Mitchel R Obey, Christopher M McAndrew, Marschall B Berkes, Jenna-Leigh Wilson

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

Brian D RustDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. rust@wustl.edu.
Daniel E PereiraDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
David W BartonDepartment of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA.
Mitchel R ObeyDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Christopher M McAndrewDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Marschall B BerkesDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Jenna-Leigh WilsonDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeBody mass index (BMI) is a recognized risk factor for infection in distal femur fracture management, but the role of local subcutaneous fat thickness at incision sites remains unclear. This study evaluated whether local adiposity independently predicts surgical site infection (SSI) after open reduction internal fixation (ORIF) and compared its predictive value to BMI.

methodsWe conducted a retrospective case–control study of 302 adults who underwent ORIF for distal femur fractures at a Level 1 trauma center (2021–2024). Subcutaneous fat depth was measured at lateral, prepatellar, and, when available, medial sites on plain radiographs. The primary outcome was SSI requiring irrigation and debridement within 1 year. Logistic regression assessed the predictive value of fat thickness and BMI, with subgroup analysis of periprosthetic fractures.

resultsNineteen patients (6.3%) developed SSI. On univariate analysis, greater lateral, prepatellar, medial fat, and BMI were significantly associated with infection. Logistic regression showed lateral and prepatellar fat predicted SSI, but these effects were lost once BMI was included, confirming BMI as the stronger independent predictor. In the periprosthetic subgroup, neither BMI nor adiposity predicted infection.

conclusionIn distal femur fractures, BMI outperformed local fat thickness as a predictor of SSI, supporting its use as a practical risk stratification tool. While greater local adiposity correlated with reoperation, these associations diminished when BMI was considered. In periprosthetic fractures, no predictors were identified, highlighting the need for larger studies to clarify whether implants alter infection risk.

Indexed as

AdiposityBody Mass IndexFemoral FracturesFracture Fixation, InternalOpen Fracture ReductionSubcutaneous FatSurgical Wound InfectionAdultAgedCase-Control StudiesFemaleFemoral Fractures, DistalHumansMaleMiddle AgedPeriprosthetic FracturesBody mass indexDistal femur fractureOpen reduction internal fixationOrthopaedic traumaSubcutaneous fat thicknessSurgical site infection

Identifiers

PMID41843213
PMCPMC12996420

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.