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

Abstract

Background: Nearly one-third of children and adolescents are overweight or obese in the United States. This study aimed to explore the difference in injury characteristics and treatment outcomes between forearm fractures in children based upon weight status.Methods: Four hundred and sixty-eight skeletally immature children sustaining forearm fractures between 2017-2019 were retrospectively reviewed. Demographics, injury characteristics, treatment methods, and complications were reviewed. Patients were analyzed by weight group: underweight, normal weight, overweight, and obese as defined by body mass index (BMI) percentile for age. Analyses were performed on dichotomized groups: underweight and normal weight (UN) versus overweight and obese (OO).Results: The median age at injury was 10 years. The distribution of BMI categories was 4.1% underweight, 56.2% normal weight, 16.2% overweight, and 23.5% obese. OO individuals were less likely to have angulated (>10 degrees) fractures in any plane (34% vs. 45%) and less likely to require closed reduction (27% vs. 37%) compared to their UN peers. Those with an acceptable cast index (less than 0.8), regardless of weight, trended towards lower rates of loss of reduction compared to those with poor cast index (17% vs. 29%). No statistically significant differences were found in rates of open fracture, low energy mechanism, operative treatment, loss of reduction, or complications between OO and UN children.Conclusions: Overweight and obese children sustain forearm fractures that are less angulated and require closed reduction at a lower rate. There are no differences in rates of open fracture, low energy mechanism, operative treatment, loss of reduction, or complications between overweight and normal-weight children treated for forearm fractures.Level of Evidence: Level III – Retrospective Cohort StudyKey Concepts•In our cohort, obese children were less likely to sustain an angulated forearm fracture greater than 10 degrees.•Obese children underwent closed reduction at a lower rate.•Both obese and non-obese children had an acceptable cast index 75% of the time.•No statistically significant differences were found in rates of open fracture, low energy mechanism, operative treatment, loss of reduction, or complications between OO and UN children.