The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting.

Introduction Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse. Methods The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed. Results The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting. Conclusions This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.

The Effect of Obesity on Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures.

Obesity is a well-recognized global epidemic that can lead to longer operative times as well as a greater technical demand. Despite this, the available literature evaluating the impact of obesity on hip hemiarthroplasty (HA) and total hip arthroplasty (THA) when treating fractures about the femoral neck is scarce. Between 2015 and 2018, we retrospectively reviewed all patients that had a HA or THA performed as treatment for an isolated fracture of the femoral neck. Patients were classified as obese and nonobese depending on current body mass index (BMI) when the index procedure was performed. Preoperative and postoperative variable were obtained from the electronic medical record. A total of 157 patients underwent hip HA or THA for an isolated fracture of the femoral neck. In those patients undergoing HA, obesity was associated with an increase in operative times (P = 0.021) and was associated with a nonsignificant increase in total operating room time (P = 0.088) and duration of anesthesia (P = 0.14). In those patients undergoing THA, obesity was associated with longer operative times (P = 0.043), total operating room time (P = 0.032), and duration of anesthesia (P = 0.045). There were no significant differences in complication rates postoperatively between obese and non-obese patients undergoing either procedure. The treatment of isolated fractures of the femoral neck with HA or THA leads to an increase in operative time without an increase in postoperative complications in obese patients.

Anomalous Posterior Tibial Artery Course-Anatomic Considerations for the Posterolateral Ankle Approach: A Case Report.

CASE: We report a unique anatomical case of an anomalous course of the posterior tibial artery found on dissection during the posterolateral approach to the ankle. To the best of our knowledge, no such case has been documented. CONCLUSION: The vascular bundle consistent with that of the posterior tibial artery and vein was encountered in the far lateral aspect of the deep posterior compartment, which suggests physicians should proceed with caution when performing the posterolateral approach to the ankle so as to avoid iatrogenic injury of this named anatomic structure.

Increased length of stay following total joint arthroplasty based on insurance type.

BACKGROUND: Increased length of stay after total joint arthroplasty has been shown to be a risk factor for peri-operative complications. The purpose of this study was to determine if Medicaid insurance would be a risk factor for increased length of stay after total joint arthroplasty. METHODS: We retrospectively reviewed a single surgeon's practice of 428 total hip and total knee arthroplasties who had insurance status of Medicaid, Medicare, Private or none. After exclusion criteria there were 400 patients. Patients with insurance status of Medicaid, Medicare or Private were then compared based on length of stay ≤ 2 days and length of stay > 2 days and then further analyzed using demographic, operative data, and total length of stay. RESULTS: Medicaid patients had an increased length of stay compared to patients with Medicare or Private insurance [1.98 days versus 1.73 days, p = .037, 95% confidence intervals (1.78-2.18) and (1.61-1.85), respectively]. The greatest predictor of a less than two-night stay post-operatively was private insurance status (p = 0.001). Medicaid patients had a higher incidence of prescribed narcotic use pre-operatively (p = 0.013). Although not significant, a trend was noted in the Medicaid population with higher incidence of smoking (p = 0.094) and illicit drug abuse (p = 0.099) pre-operatively in this sample subset. CONCLUSIONS: Patients with Medicaid insurance undergoing total joint arthroplasty have increased length of stay compared to patients with Medicare or Private insurance and have higher incidence of pre-operative narcotic use.

Preemptive multimodal analgesia and post-operative pain outcomes in total hip and total knee arthroplasty.

BACKGROUND: Use of multimodal analgesia (MMA) prior to orthopedic surgery has been adopted by many practitioners as a strategy to minimize use of opioid medications. The purpose of this investigation was to quantify the effect of a preemptive three-drug regimen (acetaminophen, celecoxib, and gabapentin) in terms of post-operative opioid consumption and pain control in the field of total joint arthroplasty. METHODS: A retrospective chart review was conducted on 1691 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and stratified by whether they received a preemptive three medication analgesic therapy (acetaminophen, celecoxib, and gabapentin) within 30 to 60 min prior to entering the operating room. Post-operative opioid consumption as well as subjectively reported patient pain scores were assessed throughout their hospital stay. RESULTS: A total of 1416 eligible patients were identified with 485 undergoing THA and 931 undergoing TKA. Statistically significant reductions in oral morphine equivalents were shown on post-operative day zero and two within the TKA cohort, and non-significant reductions were demonstrated in other intervals for both procedure types. Statistically significant reductions in patient reported pain scores were shown in nearly every time interval in both procedure types. CONCLUSION: The receipt of preemptive acetaminophen, celecoxib, and gabapentin 30-60 min prior to total joint arthroplasty demonstrated modest reductions in opioid requirements post-operatively. Patients receiving preemptive MMA reported lower pain scores throughout nearly every time interval during their admission after surgery. Further investigations are warranted regarding optimal preoperative medication therapies to promote adequate post-operative pain control-and ultimately diminished opioid consumption-in the setting of total joint arthroplasty.

The Use of Shape-Memory Alloy Staples (Nitinol) in the Treatment of Pubic Symphyseal Disruptions: Clinical Results and Radiographic Outcomes.

Nitinol is a shape-memory alloy that has many diverse applications in the field of orthopedics. There have been no previous investigations reporting clinical or radiographic outcomes of the use of nitinol staples in the definitive stabilization of the pubic symphysis. A retrospective chart review was completed on 42 patients who underwent operative stabilization of pubic symphyseal disruption at an urban level-1 trauma center. Patients treated with pelvic staples alone, or in conjunction with traditional plates and screws, were compared with those treated without the use of a shape memory alloys. Thirty-four patients were included for final analysis (8 staples and 26 controls) in this investigation. Three of eight patients in the pelvic staple group had implant failures, with two having a loss of reduction (25%); this was not significantly different from the seven hardware failures (P = 0.61) seen in the control group without any loss of reduction (P = 0.17). Failures in the nitinol staple group occurred earlier at 17.3 days compared with the control group at 101.7 days (P = 0.003). There were no significant differences between groups with regards to any of the other pre- or postoperative variables investigated. The use of nitinol staples vs. traditional plate and screw constructs for stabilizing the pubic symphysis did not result in more clinical failures. The hardware failures identified in the nitinol staple group occurred significantly earlier in the postoperative period, and were associated with a loss of reduction of the pubic symphysis.

Patients of Obese Representation Require Longer Operative Times: An Evaluation of Acetabular and Pelvic Ring Operative Duration.

Recent literature has determined that operative times for the obese population are greater for both elective and nonelective orthopedic procedures. If time allotted for a given surgical procedure is used as a measure of procedural difficulty, then consideration can be given for using an additional coding modifier (i.e., Modifier 22) for the increased skill and effort associated with longer procedures. A retrospective chart review was conducted on all patients who underwent surgical treatment for an acute fracture about the pelvis at an urban level-1 trauma center from October 1, 2010 through October 31, 2018. After allowing for both inclusion and exclusion criteria, 102 patients with acetabular fractures and 55 patients with pelvic ring injuries were included in this investigation. The obese population within the acetabular fracture cohort demonstrated significantly longer mean times for the duration of surgery, total time in spent in the operating room, and duration under anesthesia (P values of 0.038, 0.05 and 0.035, respectively). Similar results were observed with the pelvic ring injury cohort, with significantly longer procedural times (P = 0.019), total time in the operating room (P = 0.034), and total duration under anesthesia (P = 0.0395). A trend towards a greater risk of infection was found in obese patients (7%) when compared with nonobese patients (1.6%) within the acetabular fracture subset (P = 0.093). Operative duration for acetabular fractures and pelvic ring injuries is significantly longer in the obese population. Furthermore, this indicates that a Modifier 22 may be justified for the surgical treatment of these injuries in the obese and morbidly obese patient populations.

The Corkscrew Technique for Removing a Fibular Strut Allograft From the Proximal Humerus.

A fibular strut allograft is a reliable option for augmentation in open reduction internal fixation (ORIF) of proximal humerus fractures, but techniques to remove a fibular strut during revision shoulder arthroplasty are limited. Currently published techniques on extracting fibular strut grafts from humeral shafts include using a Midas burr, flexible osteotomes, humeral shaft osteotomy, and reaming. To our knowledge there has not been a technique that uses a corkscrew to remove the fibular strut from the proximal humerus in preparation for revision shoulder arthroplasty. This is a case report and description of a simple and reproducible technique that can be implemented in the setting of conversion from a proximal humerus lateral locking plate with fibular strut allograft to shoulder arthroplasty.

Weight Bearing as Tolerated After Intramedullary Nailing of the Femur: A Retrospective Analysis of Clinical and Radiographic Outcomes.

Intramedullary nailing of femur fractures has become the standard of care, with high union rates. Few high-level studies have discussed the effect that early weight bearing has on the healing of these fractures, regardless of nail size or fracture pattern. The goal of this study was to determine the clinical and radiographic outcomes of femoral shaft fractures for patients allowed immediate weight bearing after intramedullary nailing. We performed a retrospective review of 341 femoral shaft fractures, with 131 allowed immediate weight bearing, 99 allowed partial weight bearing, and 111 kept non-weight bearing. Demographic, intraoperative, and postoperative variables were collected and analyzed. Increased fracture complexity was associated with higher likelihood of delayed weight bearing. No significant difference was found for nail size or rate of failure with different nail sizes. A total of 50 nonunions were noted (14.7%), with no difference in nonunion rates between weight bearing cohorts. The only significant predictor of nonunion was Orthopaedic Trauma Association (OTA) classification of OTA32B fractures (P=.02), which were 2 times and 4 times as likely to occur compared with OTA32A and OTA32C fractures, respectively. Failure of interlocking screws occurred among 15 patients (4.4%) and was more common with older patients, osteoporotic bone, and larger diameter nails. In summary, unilateral intramedullary nailing of adult femoral shaft fractures does not show a difference in fracture union rates or implant failure with unrestricted, immediate weight bearing, regardless of nail characteristics. [Orthopedics. 2022;45(3):e148-e153.].

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients.

Introduction The Throckmorton sign, or John Thomas sign, is a well-established orthopedic eponym, anecdotally used in orthopedic surgery to correlate the direction of male genitalia, observed on a pelvic radiograph, with the laterality of an associated orthopedic pathology. In earlier studies, the direction of pelvic shadowing on X-ray has been neither a credible nor a reliable predictor of fracture laterality. Given this small body of evidence, we sought to further investigate the relationship between peri-trochanteric hip fracture laterality and male genitalia lie. Method A single-center retrospective chart review was conducted of 397 consecutive male patients who received pelvic radiographs performed upon entry to an urban level 1 trauma center. Exclusion criteria included age less than 18 years or a prior history of pelvic or urological surgery. Of this cohort, 360 patients met the inclusion criteria and underwent investigation. Results The study population had an average age of 42 years (range: 18-91 years). Statistical analysis yielded a 4.24 relative risk with pelvic shadowing laterality and respective peri-trochanteric hip fracture sidedness. Additionally, there was a 4.63 and 9.88 relative risk of tibial shaft fractures and distal radius fractures having a concomitant positive Throckmorton Sign, respectively. Conclusion Pelvic shadowing can be used as an additional diagnostic tool in predicting peri-trochanteric hip fracture sidedness in a trauma bay setting.

Treatment of Distal Femur Fractures with a Combined Nail-Plate Construct: Techniques and Outcomes.

A combination treatment using a retrograde intramedullary (IM) nail and a lateral locking plate has scarcely been described in distal femur fracture treatment. In this retrospective inquiry, we review 97 patients who were treated for distal femur fracture by one of five fellowship-trained orthopedic trauma surgeons at an urban level-1 trauma center. Of the 97 patients enrolled in this investigation, eight were treated with a combined nail-plate hybrid construct. The remaining 89 patients were treated with either traditional IM nailing (22 patients) or locking plate fixation (67 patients) alone. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and postoperative outcome measurements were recorded for each patient in the study. All eight patients who were treated with the combined nail-plate construct proceeded to fracture union (100% vs. 69% in the control group; p = 0.33). Both procedure duration (p = 0.006) and total fluoroscopy time (p = 0.004) were significantly higher in the nail-plate construct group. No statistically significant difference was found between the two groups regarding complication rate. A combined nail-plate construct is a successful treatment alternative for acute management of distal femur fractures. This technique may be most beneficial for patients at higher risk for nonunion (i.e., those with open, comminuted metaphysis fractures) or those with a need for an additional load-sharing construct (i.e, osteopenic or noncompliant patients).

Use of 3D Navigation Versus Traditional Fluoroscopy for Posterior Pelvic Ring Fixation.

Unstable pelvic ring disruption is most commonly treated with closed reduction and percutaneous screw fixation. Traditional methods involve screw placement under fluoroscopic imaging, but with recent technologic advances, intraoperative 3D navigation can now be used to help with the insertion of sacroiliac screws. Various cadaver studies have shown that placement of sacroiliac screws under 3D navigation is more accurate than placement under traditional fluoroscopic guidance. This retrospective review of 134 patients evaluated the clinical use of 3D navigation vs traditional fluoroscopy for sacroiliac screw insertion at an urban level I trauma center. Analysis of surgical data showed a significantly longer imaging time with the conventional method compared with the more experimental 3D navigation (204.06 seconds vs 66.90 seconds, P<.01). Further, a significantly larger radiation dose to both the patient and the staff was seen with traditional fluoroscopy (80.1 mGy for each) compared with that of 3D navigation (39.0 mGy and 25.1 mGy, respectively). No statistically significant difference was seen for outcome or follow-up variables between the 2 extrapolated groups. These variables included length of hospital stay, infection, nerve injury, and hardware breakage. The authors advocate that 3D navigated sacroiliac screws are safe and effective for pelvic ring stabilization; this method may be especially applicable in certain difficult imaging situations, such as morbid obesity, bowel gas interference, and overlapping pelvic structures that make the sacral corridor difficult to discern with traditional 2D fluoroscopy. Safe placement of transiliac-transsacral screws (P<.01) occurred with 3D navigation, and there was a statistically significant increase in adequate screw placement in multiple sacral segments compared with single-level stabilization (P<.01). [Orthopedics. 2021;44(4):229-234.].

Impact of perivascular lymphocytic infiltration in aseptic total knee revision.

AIMS: A limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship. METHODS: A retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter. RESULTS: Within this cohort, 118 patients (19.1%) were found to have PVLI on histological analysis. Re-revision was performed on 83 patients (13.4%) with no significant differences in all-cause or aseptic revisions between groups. A higher incidence of PVLI was noted in female patients (p = 0.037). There was no significant difference in improvement in the range of motion (p = 0.536), or improvement of KSC (p = 0.66), KSP (p = 0.61), or KSF (p = 0.3) clinical outcome scores between PVLI and no PVLI sub-groups. There was a higher incidence of a preoperative diagnosis of pain in the PVLI group compared with patients without PVLI (p = 0.002) present. CONCLUSION: PVLI found on large-scale histological analysis in TKAs at aseptic revision surgery was not associated with worse clinical outcomes or rates of re-revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):145-149.

A Modern "Nightstick Fracture" Induced by Contemporary Ballistics During the George Floyd Protests.

A 28-year-old male presented to the emergency department with an isolated ulnar shaft fracture secondary to a ballistic injury with a wooden pellet gun. This injury is also known as a "nightstick fracture," which is a common eponym in orthopedic surgery used to describe a fracture of the ulnar shaft. The eponym gained its title for the injury commonly seen when in a defensive position while being attacked with a wooden club. It is widely accepted that this infamous injury was popularized in the 1960s as a sequela of the many race-related riots across the United States. This case details how the nightstick fracture is still prevalent as a result of political protesting today, despite modern-day methods of non-lethal riot control.

Testicular Dislocation After Unstable Pelvic Ring Injury.

Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries. Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) with angiography was ordered. Arterial extravasation was noted from the bilateral anterior internal iliac arteries, which were subsequently embolized by interventional radiology. However, no concomitant genitourinary injury was identified at the time of CT. After resuscitation, the pelvis was stabilized with an anterior symphyseal plate and bilateral sacroiliac screws. During the anterior pelvic approach, the patient's dislocated testicle was surprisingly discovered inferior to the pubis. Urology was consulted intra-operatively, and the testicle was successfully relocated. At the final follow-up, the pelvic ring was healed without any noticeable urogenital complication. While testicular dislocation has been reported in the setting of pelvic ring injury, a paucity of information exists regarding management, implications, and areas for improvement in the identification of these injuries. Therefore, in cases of pelvic ring injury with significant trauma, radiologists, traumatologists, and orthopedic surgeons should adopt a multi-disciplinary approach in diligently attempting to rule out testicular dislocation pre-operatively. Intra-operatively, examination under anesthesia and careful operative technique are important in preventing iatrogenic injury.

Improved Outcomes Using a Fibular Strut in Proximal Humerus Fracture Fixation.

Proximal humerus fractures, although common, have high rates of failure after open reduction and internal fixation. The use of a fibular allograft has been explored as a means to decrease complications, particularly varus collapse and the need for revision surgery. The authors performed a retrospective review of 133 proximal humerus fractures managed surgically with locking plates (n=72) or locking plates with fibular allograft intramedullary struts (n=61). Demographic, intraoperative, and postoperative variables were collected and analyzed. The fibular allograft group was more likely to be older (P<.01), be female (P=.04), and have a history of osteoporosis (P=.01). No differences were noted in the proportions of 2-, 3-, or 4-part fractures between groups. Average follow-up was 28 weeks. Medial calcar length was longer in the locking plate only group (P=.04); however, this group demonstrated a decreased head shaft angle (P=.01) and a trend toward increased rates of varus collapse (P=.06). No significant differences were found regarding other radiographic complications, irrespective of fracture complexity. A notable decrease in fluoroscopy time was seen with strut use (P=.04), but operative time and blood loss were similar between groups. A significant decrease in revision surgery rate was found with use of an allograft strut (P=.05). Using a strut appears to preserve the radiographic head shaft angle and decrease the risk of fracture collapse in 2-, 3-, and 4-part fractures, without increasing surgical time or morbidity. Use of an intramedullary strut appears to reduce the need for revision surgery, particularly in 3- and 4-part fractures. [Orthopedics. 2020;43(5):262-268.].

Long-Term Outcomes of a Modular System in Revision Total Knee Arthroplasty.

INTRODUCTION: With the growing demand for total knee arthroplasty (TKA), the burden of revision surgery will continue to rise. Revision knee arthroplasty has historically had worse survivorship than primary knee arthroplasty. The purpose of this study is to review the 10-year outcomes and survivorship of a modular revision knee system. MATERIALS AND METHODS: A retrospective review was conducted on 109 patients (117 knees) who underwent a revision knee arthroplasty with the Vanguard® Super Stabilized Knee (SSK) Revision System (Zimmer Biomet; Warsaw, Indiana) who were eligible for 10-year minimum follow up. Clinical and radiographic data was obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter. RESULTS: With an average follow up of 10.7 years (range, 2.3 to 14.1 years), the SSK revision system exhibited a notable improvement in both clinical and functional outcomes. Average knee range of motion improvement was 4.2 degrees (SD ±18). Manipulations under anesthesia were performed in six knees (5%). Re-revisions occurred in 27 knees (23%). Ten of the re-revisions were for aseptic loosening (37%), eight for periprosthetic infection (30%), five for instability (19%), and the remainder for other aseptic causes. Mean time to failure was 4.6 years (range, 1 to 9.1 years). The 10-year all-cause survival was 77% (95% confidence interval [CI], 73 to 81%). The 10-year aseptic survival was 83% (95% CI, 79 to 87%). CONCLUSION: The findings of this study show an 83% 10-year aseptic survivorship with the Vanguard® SSK knee revision system. These results are comparable to long-term follow up of other revision knee systems.

Safety of Early Weight Bearing Following Fixation of Bimalleolar Ankle Fractures.

Ankle fractures are common orthopedic injuries. Although operative indications and subsequent stabilization of these fractures have not significantly changed, postoperative protocols remain highly variable. Effects of early weight bearing (EWB) on fracture characteristics in operatively stabilized bimalleolar and bimalleolar equivalent ankle fractures remain poorly publicized. This study seeks to clarify postoperative fracture union rates, rates of hardware loosening or failure, and radiographic medial clear space changes when comparing EWB to late weight bearing (LWB) following open reduction and internal fixation (ORIF). A total of 95 patients with either bimalleolar (66%) or bimalleolar equivalent (34%) fractures who underwent ORIF were retrospectively reviewed. Weight bearing was allowed at three weeks in the EWB group and when signs of radiographic union were noted in the LWB group. Postoperatively, patients were evaluated at regular intervals for fracture union, signs of implant failure, and evidence of medial clear space widening radiographically. There were 38 patients (40%) in the EWB group and 57 patients (60%) comprising the LWB cohort. There were no significant demographic differences between groups. The EWB group on average began to weight bear at 3.1 + 1.4 weeks postoperatively, whereas the LWB group began at 7.2 + 2.1 weeks postoperatively (p<0.01). Union rate (p=0.51), time to union (p=0.23), and implant failure (p>0.1 at all time intervals) were not notably different between groups. No differences in medial clear space were detected at any postoperative interval between groups (p>0.1 at all time intervals). This study suggests that EWB at three weeks postoperatively does not increase markers of radiographic failure compared to six weeks of non-weight bearing (NWB), which has been regarded as the gold standard of treatment to allow for healing; this may represent an improvement to rehabilitation protocols after bimalleolar ankle ORIF of unstable ankle fractures.

Suture Anchor Repair of Quadriceps and Patellar Tendon Injuries.

Operative treatment of quadriceps and patellar tendon ruptures with transosseous bone tunnels remains the gold standard, but potential benefits exist with the use of suture anchor fixation for these injuries. Such benefits include stronger biomechanical fixation, reduced soft-tissue disruption, smaller incision, reduced postoperative pain, shorter operative time, lower knot burden, lack of prepatellar bursa scarring, and avoidance of some transosseous repair risks. In this investigation, we present the reproducible technique and outcomes of using suture anchors for repair of quadriceps and patellar tendon ruptures.

The Effect of Obesity on Operative Time and Postoperative Complications for Peritrochanteric Femur Fractures.

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/m2, and a nonobese group, as defined by a BMI less than 30 kg/m2. 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.