HIGH-ENERGY TRAUMA IN MORBID-OBESITY PATIENTS

With obesity on the rise in Israel, most of the medical staff will probably encounter the unique challenges that result from the pathophysiological changes in this population. Morbid obesity is a chronic disease manifesting itself in a steady and slow-progressive increase in body weight. Currently, BMI is considered the best score for morbid obesity definition and it is calculated by dividing the body weight (kgs) in body surface area (m2). The score for morbid obesity is above 40 kg/m2 and has many systemic implications such as hypertension, diabetes, cardiovascular changes, especially it effects the musculoskeletal system. Complex multiple trauma in morbid obesity patients present a challenge throughout all stages of treatment: assessment of injury, preliminary care, and definitive surgical approach. In the last two years five morbid obese patients (all weighted more than 150 kgs) sustained various degrees of high-energy multiple-trauma and were operated on in our institution. The patient presented with the following injuries: Femoral fracture. Femoral fractures and contralateral tibial fracture. Neck of femur fracture, comminuted forearm fracture and ARDS. Pelvic fracture and ARDS. Pelvic fracture and bilateral segmental fractures of femora, bilateral patellar fractures and ARDS. The preoperative, operative and post-operative care presented special curative dilemma and pitfalls which required modifications in regular treatment modalities such as improvisation in special equipment and surgical techniques. The operating tables had to be changed so they could sustain the increased patient’s weight and allow, in the same time, modified percutaneous surgical approaches to overcome the anatomical problems. In all patients we were able to achieve the main goal of trauma treatment, i.e. stable fixation of fractures and mobilization. The experience we have gained in managing and overcoming these obstacles may serve as a basis for devising guidelines for the comprehensive treatment of these patients.