Nutritional Vulnerability Predicts Complications in Patients With Femoral Shaft Fractures
Document Type
Article
Publication Title
Injury
Abstract
Background: Malnutrition is common in orthopaedic trauma and may increase postoperative morbidity. This study evaluated the association between laboratory-defined malnutrition and 90-day medical complications and 2-year fracture-related complications after femoral shaft fracture fixation.
Methods: Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative fixation of femoral shaft fractures were identified. Malnutrition was defined as albumin ≤ 3.5 g/dL and/or leukocytes ≤ 1.5× 10³ /µL measured within 1 year before the index procedure; patients without documented laboratory-defined malnutrition served as controls. Cohorts were propensity score-matched 1:1 on demographics, comorbidities, and selected laboratory measures. Complications were assessed from postoperative day 1 through 90 days (acute respiratory failure/mechanical ventilation, DVT/PE, transfusion, postoperative infection, wound disruption, myocardial infarction, sepsis, acute kidney injury, and emergency department visit) and through 730 days (nonunion/malunion, osteomyelitis, revision fixation, and hardware removal). Risk ratios (RR) with 95 % confidence intervals (CI) were reported.
Results: After matching, 10,943 patients remained in each cohort with good covariate balance (all standardized mean differences <0.10). Within 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (21.7 % vs 9.5 %; RR 2.29 [95 % CI 2.14-2.45]), sepsis (6.1 % vs 2.9 %; RR 2.09 [1.84-2.39]), DVT/PE (9.7 % vs 5.8 %; RR 1.68 [1.53-1.85]), acute kidney injury (12.8 % vs 8.3 %; RR 1.55 [1.44-1.68]), postoperative infection (4.4 % vs 2.6 %; RR 1.68 [1.46-1.94]), wound disruption (3.1 % vs 1.9 %; RR 1.68 [1.42-2.00]), transfusion (10.9 % vs 8.5 %; RR 1.29 [1.19-1.40]), myocardial infarction (2.4 % vs 1.8 %; RR 1.30 [1.08-1.56]), and emergency department visit (16.4 % vs 14.3 %; RR 1.15 [1.08-1.23]) (all p ≤ 0.005). At 2 years, malnutrition was associated with higher risk of osteomyelitis (1.1 % vs 0.4 %; RR 2.43 [1.74-3.38]), revision fixation (5.9 % vs 4.0 %; RR 1.47 [1.31-1.66]), and hardware removal (9.3 % vs 8.1 %; RR 1.15 [1.06-1.26]) (all p ≤ 0.001), while nonunion/malunion did not differ (3.0 % vs 2.9 %; RR 1.06 [0.91-1.23]; p = 0.472).
Conclusions: Laboratory-defined malnutrition was independently associated with substantially increased 90-day morbidity and higher 2-year infectious and reoperative complications after femoral shaft fracture fixation. These findings support nutritional risk stratification and motivate prospective studies evaluating targeted perioperative optimization.
DOI
10.1016/j.injury.2026.113183
Publication Date
3-20-2026
Keywords
Femoral shaft fracture, Hypoalbuminemia, Malnutrition, Orthopaedic trauma, Postoperative complications, Propensity score matching
ISSN
1879-0267
Recommended Citation
Boutany M, Saad J, Abdelnour D, Elmenini H, Hilo AK, Francis L, Suhrawardy A, Vaidya R. Nutritional Vulnerability Predicts Complications in Patients With Femoral Shaft Fractures. Injury. 2026; . doi: 10.1016/j.injury.2026.113183.
