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Obesity and Failure of Nonoperative Management of Pediatric Both-Bone Forearm Fractures
Ugochi C. Okoroafor, MD; Jasmin L. McGinty, MD
Saint Louis University, St. Louis, MO

Introduction: Obesity is a major health problem among children in the United States. In addition to being associated with numerous comorbidities, pediatric obesity is associated with a higher prevalence and increased risk of extremity fractures. In pediatric fractures treated nonoperatively, maintaining reduction can be difficult in obese children due to the larger soft tissue envelope. The purpose of this study was to investigate the relationship between obesity and failure of nonoperative management of pediatric both-bone forearm fractures.

Materials & Methods: We conducted a retrospective review of skeletally immature patients > 2 years old who received initial orthopaedic treatment for closed radius and ulna shaft fractures at a Level I pediatric trauma center between 2011 and 2014. 145 patients who were initially treated nonoperatively with splinting or casting were included in the study. Radiographic parameters from known literature were used to assess the quality of the reduction. The patients were divided into two groups: 1) normal weight children (BMI > 5th and < 85th percentile), and 2) overweight and obese children (BMI > 85th percentile). 59% (86/145) of patients were normal weight. 41% (59/145) patients were overweight and obese. The mean patient age was 8 years in both groups. The primary outcome measure was loss of reduction, defined as the need for repeat closed reduction or surgical intervention after initial closed treatment. Secondary outcome measures included time to healing and surgical complications. For statistical analyses, Chi-square and Fisher exact tests were used for categorical variables, and t test was used for continuous variables. Statistical significance was defined as p<0.05.

Results: 16 % (14/86) of normal weight children experienced loss of reduction compared to 31% (18/59) of overweight and obese children (p=0.04). 29% (4/14) of normal weight children who lost reduction required surgery compared to 56% (10/18) of overweight and obese children (p=.12). One obese patient experienced a surgical complication. Time to healing averaged 6 weeks in normal weight children and 7 weeks in overweight and obese children (p=0.03).

Conclusion: Overweight and obese children have a significantly higher rate of loss of reduction in both-bone forearm fractures managed nonoperatively compared to normal weight children. These patients may benefit from closer clinical follow up and a lower threshold for surgical intervention.


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