Obesity and its effects on pediatric supracondylar humeral fractures.
BACKGROUND
This study evaluates the effects of childhood obesity on fracture complexity and associated injuries in pediatric supracondylar humeral fractures.


METHODS
A billing query identified all patients who were two to eleven years of age and had undergone operative treatment for extension-type supracondylar humeral fractures over a 12.5-year period. Records were reviewed for demographic data, body mass index percentile, and injury data. Complex fractures were defined as type-3 supracondylar humeral fractures, supracondylar humeral fractures with intercondylar extension, or supracondylar humeral fractures with ipsilateral upper-extremity fractures. Logistic regression analyses were used to test relationships among body mass index subgroups, fracture complexity, elbow motion, preoperative and postoperative neurovascular status, and complications.


RESULTS
Three hundred and fifty-four patients met our inclusion criteria. Forty-one children were underweight (BMI in the <5th percentile), 182 were normal weight (BMI in the 5th to 85th percentile), sixty-three were overweight (BMI in the >85th to 95th percentile), and sixty-eight were obese (BMI in the >95th percentile). There were 149 patients, eleven of whom were obese, with isolated type-2 fractures and 205 patients, fifty-seven of whom were obese, with complex fractures. Thirty-two patients had preoperative nerve palsies and twenty-eight patients had postoperative nerve palsies. Using logistic regression, obesity was associated with complex fractures (odds ratio, 9.19 [95% confidence interval, 4.25 to 19.92]; p < 0.001), preoperative nerve palsies (odds ratio, 2.69 [95% confidence interval, 1.15 to 6.29]; p = 0.02), postoperative nerve palsies (odds ratio, 7.69 [95% confidence interval, 2.66 to 22.31]; p < 0.001), and postoperative complications (odds ratio, 4.03 [95% confidence interval, 1.72 to 9.46]; p < 0.001). Additionally, obese patients were more likely to sustain complex fractures from a fall on an outstretched hand than normal-weight patients (odds ratio, 13.00 [95% confidence interval, 3.44 to 49.19]; p < 0.001).


CONCLUSIONS
Obesity is associated with more complex supracondylar humeral fractures, preoperative and postoperative nerve palsies, and postoperative complications. To our knowledge, this study is the first to assess the implications of obesity on supracondylar humeral fracture complexity and associated injuries and it validates public health efforts in combating childhood obesity.
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Mark A
MA
Seeley
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Joel J
JJ
Gagnier
The Hand Center of San Antonio, 21 Spurs Lane, Suite 310, San Antonio, TX 78240.
Ramesh C
RC
Srinivasan
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Robert N
RN
Hensinger
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Kelly L
KL
VanderHave
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Frances A
FA
Farley
Department of Orthopaedic Surgery, University of Michigan, C.S. Mott Children's Hospital, SPC 4241, 1540 East Hospital Drive, Ann Arbor, MI 48109. E-mail address for M.S. Caird: sugiyama@med.umich.edu.
Michelle S
MS
Caird
D000058:Accidental Falls / Q000706:statistics & numerical data; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005592:Fracture Fixation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D020422:Mononeuropathies / Q000209:etiology; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome