title: Do obese children experience more severe fractures than nonobese children? A cross-sectional study from a paediatric emergency department.
abstract: OBJECTIVE
  To determine whether there is an association between childhood obesity and severe extremity fractures. Associations between obesity and complications related to the fracture and/or fracture management were also examined.
  
  
  METHODS
  The present study was a retrospective, cross-sectional study conducted at a tertiary care children's emergency department. Eligible cases for review were children (two to 17 years of age) with an extremity fracture. Severe extremity fractures were defined as those requiring manipulation under anesthesia, open operative repair and/or admission to hospital. The primary outcome was the proportion of severe extremity fractures and the secondary outcome was the proportion of complications.
  
  
  RESULTS
  A total of 1340 charts of children who presented with extremity fracture from January 2008 to December 2010 were reviewed. The mean (± SD) age of the study population was 9.1±4.0 years and 62.1% were male. Overall, 19.9% (95% CI 17.8% to 22.0%) were obese and 39.6% (95% CI 36.7% to 39.1%) sustained a severe extremity fracture. The OR of severe extremity fractures among obese versus nonobese children was 1.00 (95% CI 0.76 to 1.32), adjusted for age, sex and mechanism of injury. In addition, the OR of experiencing complications among obese relative to nonobese children was 1.12 (95% CI 0.68 to 1.85).
  
  
  CONCLUSIONS
  The results of the present study demonstrated that in children with extremity fractures, obese children were not at increased risk for sustaining more severe extremity fractures or subsequent complications compared with nonobese children.
authors.affiliation: Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario;
authors.forename: Charisse
authors.initials: C
authors.lastname: Kwan
authors.affiliation: Division of Emergency Medicine, Department of Paediatrics, British Columbia Children's Hospital and University of British Columbia;
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
authors.affiliation: Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario;
authors.forename: John Paul
authors.initials: JP
authors.lastname: Oliveria
authors.affiliation: Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario;
authors.forename: Melissa
authors.initials: M
authors.lastname: Ouyang
authors.affiliation: Department of Orthopaedic Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario.
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
authors.affiliation: Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario;
authors.forename: Kathy
authors.initials: K
authors.lastname: Boutis
keywords: Child; Emergencies; Fracture; Obesity; Prevention