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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Obesity Increases the Risk of Loss of Reduction in Pediatric Both Bone Forearm Fractures
Christopher J DeFrancesco, BS; Benjamin H Rogers, BA; Apurva S Shah, MD MBA; Children's Hospital of Philadelphia, Philadelphia, PA

Title

Obesity Increases Risk of Loss of Reduction after Casting for Pediatric Both Bone Forearm Fractures: An Observational Cohort Study.

Introduction

Higher body mass index (BMI) increases the risk of loss of reduction (LOR) following closed reduction and casting for pediatric distal forearm fractures. Whether this phenomenon is also seen among pediatric both bone forearm fractures (BBFFs) is not known.

Materials and Methods

A retrospective cohort study of children aged 2 to 18 years with closed BBFFs between 2012 and 2015 at a single tertiary care children's hospital was performed. BMI percentile ?95 was defined as obese. For non-obese patients, BMI percentile ?85 was defined as overweight. BMI percentile category, fracture angulation, sex, age, fracture location, and number of follow-up visits were recorded. Radiographs and health records were reviewed to note clinical and radiographic cases of LOR. The primary outcome was LOR (clinical or radiographic).

Results

Overall, 127 subjects (75 male, 52 female) underwent acceptable closed reduction and casting (Figure 1). Median patient age was 7.8 years (range 2.2-17.8). Demographics are summarized by cohort in Table 1. There were 13 cases of LOR. As illustrated in Figure 2, LOR rates were 6.1%, 15.8%, and 44.4% for the non-overweight, overweight, and obese cohorts, respectively (p=0.003). Regression analysis revealed that LOR was positively associated with BMI percentile (odds ratio 1.06, p=0.002) and patient age in years (odds ratio 1.53, p<0.001).

Conclusions

Given the high risk of LOR in overweight and obese children with displaced BBFFs, our findings suggest that attentive and frequent follow-up is warranted. In these patients, the initial reduction should be closely scrutinized, and especially in older children a lower threshold for surgical fixation may be considered.

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