Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?

Abstract

Background: Nearly 1 in 5 American children are obese. The primary purpose of this study is to evaluate the relationship between childhood obesity and perioperative complications, patient-reported outcomes (PRO), and functional recovery after closed reduction and percutaneous pinning (CRPP) of type II and III supracondylar humerus fractures. Methods: Retrospective review of patients treated operatively with CRPP of Wilkins modification of the Gartland classification type II and III supracondylar humerus fractures was performed over a 1-year timeframe (July 1, 2016 to July 1, 2017). One hundred forty-four patients under the age of 16 treated were identified. Obesity was defined as body mass index (BMI) at or above the 95th percentile for age. Obesity as a risk factor for poor outcomes was assessed. The primary outcome measure was postoperative PRO [quick-DASH, Patient Reported Outcomes Measurement Information System (PROMIS)-UE, PROMIS Global Health, and PROMIS Pain scores]. Results: Mean age at surgery was 5.9 years (SD=2.1, 1.07 to 12.2) and mean age at final follow-up (3.3 y) was 8.8 (SD=2.14, 4 to 16). Mean patient BMI was 17.2 (SD=4.48, 12.4 to 56.2). Sixty-six patients were female (45.8%) and 78 patients were male (54.2%). In all, 31 of 144 patients (21.5%) met criteria for obesity. Obesity (95th percentile for BMI or above) was not associated with a higher rate of complications overall (χ2=1.29, P=0.256), range of motion loss (χ2=0.2, P=0.655) or requirement of postoperative physical therapy (χ2=0.17, P=0.678). Seventy-five patients were available and willing to participate in the outcomes score assessments. Mean follow-up for this cohort of 75 patients was 3.3 years (SD=0.31, 2.85 to 3.88). There were no differences in PROMIS pain, PROMIS upper extremity function, PROMIS general health, or quick-DASH scores when comparing obese with nonobese patients. Conclusions: Obesity is a growing concern in the United States and its effect on long-term outcomes after CRPP of supracondylar humerus fractures is unknown. The present study demonstrates no difference in complications or PRO among obese patients compared with nonobese patients. Level of Evidence: Level IV—retrospective cohort study.

PROMIS Utilization in Pediatric Orthopaedics: A Scoping Review

“…A total of 51 studies8–10,17–64 of PROMIS in pediatric orthopaedics were identified in the current review. Study characteristics by year, author, orthopaedic population, topic, and cohort size can be found in Appendix, Supplemental Digital Content 1, http://links.lww.com/BPO/A524.…”

“…There were 1961 unique citations included after the removal of 1756 duplicates. After initial screening, 183 studies were screened under full-text review leaving a final number of 51 studies8–10,17–64 included in this scoping review (Fig. 1).…”

“…The methodology of the studies included 3 categories: (1) Outcome studies [8][9][10]17,18,[23][24][25][26][27][28][29][30][34][35][36][37][38][40][41][42]47,48,55,57,[59][60][61][62][63][64] in which baseline PROMIS scores were assessed in a specific disease state or to evaluate the outcome of a surgical procedure or treatment (n = 31, 60.8%), (2) PROM comparison studies 8,[19][20][21][22][23]29,31,33,39,41,[43][44][45][46]49,54,56,58 in which PROMIS was compared with a legacy PROM within a ...…”

Do Obese Children Have Poor Patient-reported Outcomes After Closed Reduction and Percutaneous Pin Fixation of Supracondylar Humerus Fractures?

“…We read with interest the recent publication by Sullivan et al 1 Liu et al 2 reported that the first 15 Gartland type III cases operated on by fellows without a pediatric orthopaedic surgeon (PO) present were associated with an increased nonideal reduction rate and loss of reductions and therefore recommended for a PO to be available during the first 15 cases.…”

“…We read with great interest the study by DiBartola et al1 in which they have tried to answer whether obese children have poor patient-reported outcomes (PROs) after closed reduction and percutaneous pin fixation of supracondylar humerus fractures. However, there are certain concerns which need to be addressed before the conclusions can be accepted. There are 2 similar yet different Patient-Reported Outcomes Measurement Information System (PROMIS) measures2 for assessment in pediatric patients.…”