{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T14:34:31Z","timestamp":1778337271104,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. Methods: In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient\u2019s ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO\u2019s BMI groups. Results: The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 \u00b1 4.8 days), normal (13.6 \u00b1 7.8 days), overweight (14.2 \u00b1 11.7 days), and obese patients (16.0 \u00b1 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 \u00b1 42.9 min; normal weight = 90.2 \u00b1 38.2 min; overweight = 99.9 \u00b1 39.9 min; obese = 117.2 \u00b1 61.5 min (p &lt; 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5\u201330 kg\/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient\u2019s ability to walk on crutches. Conclusion: Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function.<\/jats:p>","DOI":"10.3390\/jcm9072076","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T05:00:08Z","timestamp":1593666008000},"page":"2076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures"],"prefix":"10.3390","volume":"9","author":[{"given":"Michael","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Gutwerk","sequence":"additional","affiliation":[{"name":"Orthop\u00e4die, Sport- &amp; Unfallklinik, Ev.-Luth. Diakonissenanstalt, 24939 Flensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederik","family":"Greve","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"V\u00f6lker","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9956-0619","authenticated-orcid":false,"given":"Michael","family":"Zyskowski","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlodwig","family":"Kirchhoff","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Biberthaler","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Pf\u00f6rringer","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2420-7201","authenticated-orcid":false,"given":"Karl","family":"Braun","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Unfallchirurgie, Klinikum rechts der Isar, Technische Universit\u00e4t M\u00fcnchen, 81675 M\u00fcnchen, Germany"},{"name":"Centrum f\u00fcr Muskuloskeletale Chirurgie, Charit\u00e9 Universit\u00e4tsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.bone.2003.10.001","article-title":"Fracture incidence and association with bone mineral density in elderly men and women: The Rotterdam study","volume":"34","author":"Schuit","year":"2004","journal-title":"Bone"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1055\/s-2006-926637","article-title":"Incidence of hip fracture in Germany\u2014Person-related analysis of health insurance population","volume":"68","author":"Hoffmann","year":"2006","journal-title":"Gesundheitswesen"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"M635","DOI":"10.1093\/gerona\/54.12.M635","article-title":"Intertrochanteric versus femoral neck hip fractures: Differential characteristics, treatment, and sequelae","volume":"54","author":"Fox","year":"1999","journal-title":"J. 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