Complications with flexible nailing of femur fractures more than double with child obesity and weight >50 kg

Abstract

Background Previous studies report that children above the 95th percentile in weight for their age had an increased risk for complications following titanium elastic nailing for femur fractures. The purpose of this study is to examine whether obesity, defined as body mass index (BMI) [ 95th percentile, and/or simple weight correlates with an increased rate of complications. Methods The incidence of complications was compared between obese and non-obese patients and also between patients who weighed C50 kg and those \50 kg. Results The overall complication rate was 23% (16/71). The complication rate was 17% (10/58) for ''non-obese'' patients and 46% (6/13) for ''obese'' patients. This difference was statistically significant (P = 0.03). The complication rate was 46% (6/13) in children who weighed C50 kg and 17% (10/58) in children who weighed\50 kg. This difference was also statistically significant (P = 0.03). Conclusions This study demonstrates that obesity (BMI [ 95th percentile) and weight over 50 kg predispose patients to increased risk of surgical complications when undergoing flexible elastic nailing for femur fractures. Both obese children and children weighing C50 kg were two times more likely to have a complication when undergoing this procedure.

Does Pediatric Body Mass Index Affect Surgical Outcomes of Lower-Extremity External Fixation?

“…8 This retrospective study of 71 patients found a 46% complication rate (6/13) in obese children as compared with 17% (10/58) in those who were not obese. Garner and colleagues found a similar rate of complications in their retrospective weightmatched cohort study of children >47 kg undergoing operative fixation for a femur fracture with either titanium elastic nails or rigid trochanteric locked intramedullary nails.…”

“…[4][5][6][7] In pediatric orthopaedics, the literature has mostly been limited to studies examining the impact of weight and obesity on treatment of lower-extremity fractures, predominantly those involving the femur. [7][8][9] The results of these studies have not consistently demonstrated the effects of obesity on outcome.…”

Fixation of Length-Stable Femoral Shaft Fractures in Heavier Children

“…Titanium elastic nailing in this population had 6 of 15 incidence of complications, slightly less than the 46% to 50% noted in earlier studies. 13,14,16 This can be compared with 10 of 15 in the RLN cohort (P=0.17). Further analysis showed that, although not managed to reach statistical significance, the titanium elastic nails had a higher rate of malunion ( This study has several weaknesses.…”

“…This is a result of a number of factors, including the number of heavier children treated with TEN being limited because of current trends in fracture management, and the fact that we lost additional cases because of the weightmatching process. For these reasons, we chose a cutoff of 47 kg, not the 50 kg recommended by other investigators, 13,16 to allow for the inclusion of 2 additional matched groups (4 patients total). Considering our small numbers, we believe that the inclusion of these patients strengthens our data; further, only 1 of the 3 patients below 50 kg was treated with flexible intramedullary nailing.…”

“…[7][8][9][10][11][12] Recent studies, however, have suggested that flexible nailing may be associated with an increased rate of complications when used in heavier children and in length-unstable fracture patterns. [13][14][15][16] As the use of rigid locking nails (RLNs) with a piriformis fossa entry point has been limited in children because of the risk of avascular necrosis, 17,18 the newer lateral or trochanteric entry nails provide an option for rigid, locked fixation in the skeletally immature. 9,[19][20][21][22] The purpose of this study was to compare the treatment of length-stable diaphyseal femur fractures with either titanium elastic nails (TENs) or RLNs in a matched cohort of heavier children (>47 kg).…”