title: Childhood obesity as a risk factor for lateral condyle fractures over supracondylar humerus fractures.
abstract: BACKGROUND
  Obese children reportedly have an increased risk of sustaining musculoskeletal injuries compared with their normal-weight peers. Obese children are at greater risk for sustaining fractures of the forearm, particularly from low-energy mechanisms. Furthermore, obesity is a risk factor for sustaining an extremity fracture requiring surgery. However, it is unclear what role obesity plays in fractures about the distal humerus.
  
  
  OBJECTIVE
  We therefore asked whether (1) children who sustain lateral condyle (LC) fractures have a higher body mass index (BMI) as compared with those with supracondylar (SC) humerus fractures; and (2) children with a higher BMI sustain more severe fractures regardless of fracture pattern.
  
  
  METHODS
  We retrospectively reviewed 992 patients: 230 with LC injuries and 762 with SC fractures. We determined BMI and BMI-for-age percentiles. Fracture types were classified by the systems proposed by Weiss et al. (LC fractures) and Wilkins (SC fractures).
  
  
  RESULTS
  The LC group had both a higher mean BMI and BMI-for-age percentile than the SC group as well as had more obese patients (37% versus 19%). Within the LC group, children with Type 3 fractures had a higher BMI that those with Type 1 fractures (19 versus 17). There was a higher percentage of obese patients with Type 3 LC fractures compared with Type 1 and 2 fractures (44% versus 27% and 26%). Among patients with SC fractures, there was no difference among the BMI, BMI-for-age percentiles, or percentage of obese children when analyzed by fracture subtype.
  
  
  CONCLUSIONS
  Obesity places a child at greater risk for sustaining a LC fracture and when these fractures occur, they are often more severe injuries compared with those in nonobese children.
  
  
  METHODS
  Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Pediatric Orthopedics, Rady Children's Hospital and Health Center, San Diego, CA 92123, USA. fornari.eric@gmail.com
authors.forename: Eric D
authors.initials: ED
authors.lastname: Fornari
authors.forename: Mike
authors.initials: M
authors.lastname: Suszter
authors.forename: Joanna
authors.initials: J
authors.lastname: Roocroft
authors.forename: Tracey
authors.initials: T
authors.lastname: Bastrom
authors.forename: Eric W
authors.initials: EW
authors.lastname: Edmonds
authors.forename: John
authors.initials: J
authors.lastname: Schlechter
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D007223:Infant; D008297:Male; D009765:Obesity / Q000150:complications* / Q000503:physiopathology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors