Obese Children Have Different Forearm Fracture Characteristics Compared With Normal-weight Children

Abstract

Background: Current estimates suggest that one third of children and adolescents are overweight and 1 in 5 are obese. Obese children are at increased risk of sustaining more complex fractures, failing nonoperative treatment, and experiencing more complications during treatment. The purpose of this study was to compare forearm fracture characteristics, treatment, and complications in grouped overweight and obese [OW+OB; body mass index-for-age percentile (BMI%) ≥85] pediatric patients compared with normal-weight (NW; BMI%≤84) patients. Methods: This was a retrospective comparative study of patients aged 2 to 17 years old who presented with a forearm fracture resulting from low-energy trauma between January 2010 and September 2017. Patients with incomplete height and weight data; an underlying condition that predisposes to fractures or altered fracture healing; and torus, greenstick, pathologic, and high-energy fractures were excluded. Demographics, fracture characteristics, treatment, and complications were recorded. Descriptive and inferential analyses were conducted. Results: A total of 565 patients (403 NW, 162 OW+OB) met the inclusion criteria. NW children sustained open fractures nearly twice as frequently as the OW+OB children but this was not statistically significant (9.7% vs. 4.9%; P=0.065). Subanalysis showed that NW children were 4.1 times more likely to sustain an open fracture compared with obese (BMI%≥95) children (9.7% vs. 2.4%; P=0.029). A significant relationship was found between BMI% and location of the fracture, the bones involved, and fracture type. The OW+OB children sustained more distal forearm fractures than midshaft and proximal forearm fractures. Isolated radial shaft fractures were more common in the OW+OB group, whereas isolated ulnar shaft fractures were more common in the NW group. There was no difference in associated neurovascular injury, initial nonoperative versus operative management, failure of nonoperative treatment, and treatment complications. Conclusions: OW+OB children have different forearm fracture characteristics compared with their NW peers. The thick soft tissue envelope in obese children may be protective against an open forearm fracture. In contrast to previous studies, obesity was not associated with failure of nonoperative treatment or a higher rate of complications. Level of Evidence: Level III—prognostic.

Do Forearm Fracture Characteristics and Outcomes Differ Between Obese and Non-Obese Children?

“…The findings of our study are contrary to previously published studies that demonstrate higher rates of malreduction, loss of initial reduction, failure of nonoperative management, and need for additional intervention in obese children. [4][5][6][7][8] Differences in study design between this study and previous studies may account for the contrasting findings. Of these studies, only one reported on cast index.…”

“…Li et al found that obese children more commonly fracture the distal third of the forearm and that obesity may be protective against open fractures; their data did not demonstrate an increase in complication rates or failure of closed treatment. 5 Auer et al found that obese children undergoing closed reduction of forearm fractures had higher rates of malreduction and more than double the rate of closed reduction in the operating room compared to their normal-weight peers. 6 Several other studies have found a higher rate of treatment failure in obese children with forearm fractures treated nonoperatively.…”

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

“…Single bone forearm fractures are far less common and are typically the result of direct trauma. However, single bone forearm fractures of the ulna or radius should always raise suspicion for a Monteggia or Galeazzi fracture dislocation, respectively [ 10 , 11 ]. Understanding the deforming forces is essential to the reduction in both-bone forearm fractures (Fig.…”

Obesity Increases Time to Union in Surgically Treated Pediatric Fracture Patients

“…Preoperatively, obesity has been shown to increase the risk of fractures and fracture severity, and the complexity of the fracture type. 14 - 16 Intraoperatively, a larger body habitus can make surgical procedures more technically challenging because anatomical landmarks are harder to delineate and can cause longer surgical times for patients. 7 Postoperatively, childhood obesity has been linked to increased risk of nerve palsies, wound infection, wound dehiscence, delayed healing, and refracture through an old fracture site.…”