Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures

Abstract

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.

Asthma, bones and corticosteroids: Are inhaled corticosteroids associated with fractures in children with asthma?

“…This enabled us to perform extensive analysis on the association between ICS use in asthmatic patients and fracture risk factors. This was particularly useful here as recent studies have shown BMI to be associated both with the severity of asthma symptoms, as well as an increased risk of fractures in general …”

The role of PPARγ in childhood obesity-induced fractures

“…There is current debate and conflicting studies as to whether increased adiposity leads to larger bones, increased or decreased density, or increased fractures rates (Table 1). Not only are obese children more likely to have fractures but once they do, these children have a higher rate of improper bone reductions and require more subsequent manipulations to correct the misaligned bones [49]. Additionally, children with higher BMIs have a greater prevalence of open reduction surgery to repair their factures [49], which leads to increased surgery complications [50] and more cosmetic scarring compared to closed reductions.…”

“…Not only are obese children more likely to have fractures but once they do, these children have a higher rate of improper bone reductions and require more subsequent manipulations to correct the misaligned bones [49]. Additionally, children with higher BMIs have a greater prevalence of open reduction surgery to repair their factures [49], which leads to increased surgery complications [50] and more cosmetic scarring compared to closed reductions. Fueling further complexity, it has also been shown that where the deposition of adiposity is localized also has an impact on bone strength.…”

Incidence and risk factors for redisplacement after closed reduction and instant rigid cast immobilization for paediatric distal radius fractures: a case control study

“…The rates of redisplacement in cast have been reported to range from 21 to 39% after acceptable initial reduction [10,11]. Factors that have been implicated in loss of reduction in children are numerous, and different studies undertaken to define their roles have not been able to give convincing results [12][13][14][15].…”