Elevated BMI is associated with intra-articular comminution, prolonged operative time, and postoperative complications in distal radius fractures

•We hypothesized that an elevated BMI would be associated with increased intra-articular comminution in operative distal radius fractures, as well as longer operative times, and higher surgical complications.•Using the NSQIP database, a retrospective analysis was performed to assess the relationship between BMI and open treatment of distal radius fractures.•Over 11,000 patients met inclusion criteria. For every increase in BMI point, there was an increased risk of intra-articular split fracture by 1.7% (OR 1.017, 95% CI 1.010–1.023, p < 0.01) and increased risk of intra-articular comminution by 3.1% (OR 3.1, 95% CI 1.025–1.037, p < 0.01).•Additionally, there was a positive association between BMI and prolonged OR time as well as increased risk for return to the OR. Obesity continues to be a problem in the United States with greater than 35% of the adult population affected. Obesity influences fracture care as it affects impact forces, alters cellular pathways of healing, and is often associated with higher complication rates. Distal radius fractures are among the most common fracture patterns in the adult population. The purpose of this study was to evaluate the effect of BMI on the degree of intra-articular fracture comminution, operative time, and return to the OR in obese patients who underwent operation for distal radius fractures. A retrospective analysis of the American College of Surgeons National Surgical Improvement Program's (ACS-NSQIP) database was performed and logistic regressions were used to assess the relationship between BMI and open treatment of distal radius fractures. Three separate CPT codes were used to distinguish between extra-articular fractures, intra-articular split fracture, and intra-articular fracture with comminution. Percutaneous or closed treatment of distal radius fractures were excluded. A total of 11,228 patients (mean age 65.1 years) with open reduction and internal fixation of distal radius fractures were identified. For every increase in BMI point, there was an increased risk of intra-articular split fracture by 1.7% (OR 1.017, 95% CI 1.010–1.023, p < 0.01) and increased risk of intra-articular comminution by 3.1% (OR 3.1, 95% CI 1.025–1.037, p < 0.01). Additionally, for every increase in BMI point, the risk of a surgical complication increased by 2.3% This nationally representative, population-based study demonstrates that elevated BMI is associated with increased risk for intra-articular involvement and higher risk