COMPLICATIONS AND DIFFICULTIES OF MANAGEMENT OF NONUNION IN THE SEVERELY OBESE

Operative fixation of 22 nonunited fractures was undertaken in 21 obes e patients. Eleven patients were women and 10 were men, with an averag e age of 46.3 years (range 25-74). The average body mass index in this group of patients was 37.9 kg/m(2) (range 33.2-57.1), Two patients we re classified as morbidly obese and 19 as severely obese. The manageme nt of these patients proved to be fraught with difficulties related to their obesity. There were a number of occurrences believed to be rela ted to poorly protective positioning and prolonged ischemic pressure u nder the patient's body weight during the administration of anesthetic , including a peroneal compartment syndrome, a gluteal compartment syn drome with sciatic nerve palsy, bilateral brachial plexus stretch inju ries, an anterior interosseous nerve palsy, and the postoperative deve lopment of a patch of scalp alopecia. There were two wound separations and no episodes of thromboembolic disease. Sixteen nonunited fracture s healed after the index procedure at an average time to healing of 5. 6 months (range 2-14). Five nonunited fractures required a second proc edure to gain union [average total time to healing 17 months (range 10 -31)]. A single fracture remains ununited. Awareness of the unique tec hnical demands and operative and anesthetic risks encountered when und ertaking an operative procedure in a severely obese patient is imperat ive for the safe and successful treatment of orthopaedic surgical prob lems in these patients.