Introduction The high prevalence of obesity among adults in the United States presents significant challenges to orthopedic surgeons. Obesity has been shown to increase operative time and complications in both elective and nonelective orthopedic surgeries. Despite this, there is a lack of literature evaluating the effect obesity has on operative time and postoperative complications following peritrochanteric fracture surgery. Methods and Materials We performed a retrospective review of patients who underwent isolated operative stabilization of a peritrochanteric femur fracture at our urban level one trauma center between 2010 and 2018. Patients were divided into an obese group, as defined by a body mass index (BMI) equal to or greater than 30 kg/m(2), and a nonobese group, as defined by a BMI less than 30 kg/m(2). Operative timing variables including time to surgery, operative time, total operating room (OR) time, anesthesia time, and fluoroscopy time were collected. Postoperative variables evaluated including the presence of a major postoperative complication within 90 days of surgery, the need for repeat surgery within 90 days, and the need for surgery due to an infection within 90 days were collected. Results A total of 175 patients were included in this retrospective review. Thirty-seven patients were included in the obese group, and 138 were included in the nonobese group. Obesity was associated with a significantly (p = 0.002) longer operative time, total OR time (p = 0.0001), anesthesia time (p = 0.00006), and fluoroscopy time (p = 0.0001). There was no significant difference (p > 0.05) in postoperative variables between the obese and nonobese group. The 90-day major postoperative complication rate was 10.8% in the obese group and 10.9% in the nonobese group. Both repeat surgery and surgery for infection within 90 days were 2.7% in the obese group and 1.4% in the nonobese group. Conclusion The treatment of peritrochanteric femur fractures in obese patients is associated with a significantly longer operative time, total OR time, anesthesia time, and fluoroscopy time, but no difference in major postoperative complications when compared to nonobese patients.

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 9.02 compared to 7.24 (p=0.02). Patients with diabetes had a significantly higher rate of undergoing amputation when diagnosed with NF (p<0.0001). The mortality rate for diabetes and non-diabetes cohorts were 30.9% and 18.9%, respectively (p=0.2). Conclusion This study demonstrated that patients with diabetes with confirmed NF of an extremity had a significantly higher LRINEC score were more likely to undergo an amputation primarily, and were more likely to have a polymicrobial infection compared to those without. The overall mortality rate of NF was 26.1%.

Background. As an alternative to traditional open reduction internal fixation of ankle fragility fractures, primary retrograde tibiotalocalcaneal (TTC) nailing has been investigated as a treatment option. These results suggest that this treatment is an acceptable alternative treatment option for these injuries. There are still questions about the need for formal joint preparation at the subtalar or tibiotalar joint when performing primary TTC nailing for fragility fractures. Methods. In this study, we retrospectively evaluated 32 patients treated with primary retrograde TTC nail without subtalar or tibiotalar joint preparation for a mean of 2.4 years postoperatively. We specifically reviewed the charts for nail breakages at either joint, patients developing subtalar or tibiotalar joint pathology requiring additional treatment, including return to the operating room for formal joint preparation. Results. Fracture union occurred in 100% of patients. There were 3 cases (10.0%) of hardware failure, and 2 of these cases were asymptomatic and did not require any treatment. One patient (3.3%) developed hardware failure with nail breakage at the subtalar joint. This patient developed progressive pain and symptoms requiring revision surgery with formal arthrodesis of the subtalar and tibiotalar joint. Conclusions. This study shows that retrograde hindfoot nailing without formal subtalar or tibiotalar joint preparation is an acceptable potential treatment option in ankle fragility fractures. Mid-term follow-up demonstrates favorable outcomes without the need for formal joint preparation in this high-risk population. Comparative studies with higher patient numbers and long-term follow-up are needed to confirm the results of this study. Levels of Evidence: Level IV.