KEY WORDS client-centred practice, information gathering and collaborative goal setting, musculoskeletal/hand therapy, occupational performance, occupational therapy theory and models.

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Background: Childhood obesity is a national problem that has gained significant attention in both the medical literature and the national media. Obesity in the adult population has been associated with increased failure of conservative treatments. Our hypothesis is that childhood obesity is associated with a loss of reduction after closed treatment of distal radius fractures. Methods: A total of 157 patients with consecutive distal radius fractures who underwent closed reduction in the emergency department or the operating room were included from the office records of the sole pediatric orthopaedic subspecialist group in a metropolitan area from January 2011 to June 2012. All cases were initially treated with fiberglass casting with or without closed reduction. All patients completed the casting treatment and demonstrated radiographic union. Patients' age, weight, height, number of office visits, subsequent surgeries, and fracture angulation were recorded and analyzed. Results: Sixty-six (42%) children were overweight (BMI > 85th percentile) and 46 (29%) children met the criteria for obesity (BMI > 95th percentile). Fourteen normal-sized children (12%) and 13 obese children (28%) required a reduction in the operating room after initial treatment, which was significant (P = 0.02). Obese children needed significantly more visits requiring radiographs (P = 0.004). Obese children were significantly less likely to have an initial perfect reduction in the emergency room (P = 0.005). Conclusions: The results of closed reduction and casting for displaced distal radius fractures are typically excellent with few complications or risks. The present study supports the hypothesis that obesity results in a higher rate of malreduction and subsequent manipulations with closed reduction and casting. Close follow-up and early consideration for additional treatment in this patient population may help reduce the need for further manipulations. Level of Evidence: Level III.