Impact of obesity on operative treatment and inpatient outcomes of paediatric limb fractures

Abstract

AimsThe aim of this study was to utilize a national paediatric inpatient database to determine whether obesity influences the operative management and inpatient outcomes of paediatric limb fractures.Patients and MethodsThe Kids’ Inpatient Database (KID) was used to evaluate children between birth and 17 years of age, from 1997 and 2012, who had undergone open and closed treatment of humeral, radial and ulna, femoral, tibial, and ankle fractures. Demographics, hospital charges, lengths of stay (LOS), and complications were analyzed.ResultsObesity was significantly associated with increased rates of open reduction and internal fixation (ORIF) for: distal humeral (odds ratio (OR) = 2.139, 95% confidence interval (CI) 1.92 to 3.44; p < 0.001); distal radius and ulna fractures (OR = 1.436, 95% CI 1.14 to 2.16; p < 0.05); distal femoral (OR = 2.051, 95% CI 1.69 to 3.60; p < 0.05); tibial and fibula shaft (OR = 2.101, 95% CI 2.10 to 3.50; p < 0.001); and ankle (OR = 1.733, 95% CI 1.70 to 2.39; p < 0.001). Older age was significantly associated with ORIF for all fractures (p < 0.05). LOS, hospital charges, and complications were significantly increased in obese patients following ORIF for upper and lower limb fractures (p < 0.05).ConclusionObese paediatric patients are more likely to undergo ORIF in both upper and lower limb fractures and have more inpatient complications. These findings may assist in informing obese paediatric fracture patients and their families regarding the increased risk for open operative fixation and associated outcomes. Cite this article: Bone Joint J 2019;101-B:491–496.

A Perspective on Management of Limb Fractures in Obese Children: Is It Time for Dedicated Guidelines?

“…Obese children have genetic, hormonal, and clinical differences compared to healthy patients. Obesity is associated with altered metabolic patterns and changes in bone composition (5,10,13). The altered bone structure and bone mass accrual are related to higher fracture rates, and these altered bones are more likely to sustain growth plate fractures in the limbs.…”

“…Obese children have a higher risk of loss of reduction of forearm fractures treated both by casting and open reduction (3). Obesity is also related to an increased rate of open reduction and internal fixation of limb fractures (10).…”

“…Several studies suggest that obesity could influence the natural history of pediatric limb fractures, modifying the standard treatment management (9,10). A high body weight contributes to increasing the fracture risk and modifying bone proprieties, thus resulting in a less strong bone and consequently a higher risk of fracture.…”

Effect of obesity on mortality among hospitalized paediatric patients with severe sepsis

“…The impact of obesity has been evaluated in children with various conditions such as respiratory infections, limb fractures and asthma and investigators found that obesity was associated with an increasing severity of the disease and morbidity 21‐23 . There is a lack of population level data exploring the relationship between obesity and outcomes in severe sepsis in the paediatric population.…”

“…7,13,[18][19][20] The impact of obesity has been evaluated in children with various conditions such as respiratory infections, limb fractures and asthma and investigators found that obesity was associated with an increasing severity of the disease and morbidity. [21][22][23] There is a lack of population level data exploring the relationship between obesity and outcomes in severe sepsis in the paediatric population. We sought to evaluate the effect of obesity on hospital mortality rates among paediatric patients with severe sepsis (PSS) and healthcare resource utilization.…”