title: Influence of obesity on surgical outcomes in type III paediatric supracondylar humeral fractures.
abstract: BACKGROUND
  Obesity was associated with poor treatment outcome in paediatric supracondylar humeral fractures. It is controversial about the association is related to more severe fractures in obese children or obesity directly affects treatment. The purpose of this study was to evaluate the influence of obesity on surgical outcomes after control of fracture severity.
  
  
  METHODS
  This is a retrospective comparative study of 107 children treated for type III supracondylar humeral fractures between January 2009 and December 2013. Children were classified according to sex-specific body mass index (BMI)-for-age growth chart into 4 groups: underweight group (n=10); normal-weight group (n=71); overweight group (n=13); and obese group (n=13). Clinical outcomes were assessed using the Flynn criteria. Radiographic evaluation included the Baumann angle and the lateral humerocapitellar angle. Loss of reduction was defined by Skaggs' criteria.
  
  
  RESULTS
  The mean age, sex, and Flynn criteria were comparable among the four BMI groups. Obese children were more likely to develop a varus change in the Baumann angle (p=0.017) and loss of reduction in varus (p=0.059) postoperatively. The risk for pin-related complications was significantly higher in overweight and obese children (p=0.013).
  
  
  CONCLUSIONS
  Obesity was associated with more postoperative varus deformation and pin-related complications after surgical fixation for type III supracondylar fracture. These findings underline the importance of stable fixation and close post-operative monitoring in obese children.
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. Electronic address: chiahchang@gmail.com.
authors.forename: Chia-Hsieh
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Hsuan-Kai
authors.initials: HK
authors.lastname: Kao
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Wen-E
authors.initials: WE
authors.lastname: Yang
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D063766:Pediatric Obesity / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Child; Elbow; Humeral fractures; Obesity