Malnutrition at the Time of Surgery Predicts Increased Morbidity After Distal Femur Fracture Fixation: A Propensity-Matched Analysis

Authors

• Jawad Saad, Wayne State University School of MedicineFollow
• Amir Ghafarian, International University of the Health SciencesFollow
• Tyler Forbes, Wayne State University School of MedicineFollow
• Muaaz Wajath, Michigan State University College of Human MedicineFollow
• Noor Saad, American University of the Caribbean School of MedicineFollow
• Khaled Saleh, FAJR GlobalFollow

Research Mentor Name

Khaled Saleh

Research Mentor Email Address

kjsaleh@gmail.com

Institution / Department

Wayne State University School of Medicine; data analyzed using the TriNetx US Collaborative Network

Document Type

Research Abstract

Research Type

clinicalresearch

Graduate Level Research

no

Abstract

Abstract

Background: Distal femur fractures (DFF) are serious injuries most often affecting older adults with multiple medical comorbidities. Malnutrition is known to worsen outcomes in elective orthopedic surgery, but its impact in urgent DFF fixation, where optimization time is limited, remains unclear. This study evaluated whether preoperative malnutrition predicts 90-day morbidity after DFF fixation and whether implant choice influences risk among malnourished patients.

Methods: Adults undergoing operative DFF fixation from 2005–2025 were identified using the TriNetX U.S. Collaborative Network. Malnutrition was defined as serum albumin ≤3.5 g/dL or leukocyte count ≤1.5×10³/µL within one year preoperatively. After 1:1 propensity matching for demographics and comorbidities, outcomes were compared between 13,924 malnourished and 13,924 non-malnourished patients. A secondary matched analysis compared plate versus intramedullary nail fixation in malnourished patients (n=662). Ninety-day postoperative complications were assessed.

Results: Malnourished patients had significantly higher rates of nearly all 90-day complications, including sepsis (RR 3.55), surgical site infection (RR 3.05), wound disruption (RR 3.38), pulmonary embolism (RR 2.09), pneumonia (RR 2.45), renal failure (RR 2.53), anemia (RR 1.97), and transfusion (RR 2.52) (all p< 0.001). Readmission and opioid-related outcomes were also elevated. Among malnourished patients, complication rates were similar between plate and nail fixation, with the exception of lower pneumonia rates in plate fixation (p=0.045).

Conclusion: Preoperative malnutrition is a strong, independent predictor of postoperative morbidity after DFF fixation, and risk remains high regardless of implant choice. Early nutritional screening and targeted perioperative optimization should be integrated into trauma workflows to improve outcomes for this vulnerable population.

Disciplines

Medical Anatomy | Medical Nutrition | Medicine and Health Sciences | Musculoskeletal, Neural, and Ocular Physiology | Nutritional and Metabolic Diseases

Recommended Citation

Saad, Jawad; Ghafarian, Amir; Forbes, Tyler; Wajath, Muaaz; Saad, Noor; and Saleh, Khaled, "Malnutrition at the Time of Surgery Predicts Increased Morbidity After Distal Femur Fracture Fixation: A Propensity-Matched Analysis" (2026). Medical Student Research Symposium. 502.
https://digitalcommons.wayne.edu/som_srs/502