Next Article in Journal
Incidence, Predictors and Outcomes of Noninvasive Ventilation Failure in Very Preterm Infants
Previous Article in Journal
Online Assessment of Motor, Cognitive, and Communicative Achievements in 4-Month-Old Infants
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 9
Issue 3
10.3390/children9030425
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?

by
Andrea Vescio
1,
Gianluca Testa
1,
Marco Sapienza
1,
Alessia Caldaci
1,
Marco Montemagno
1,
Antonio Andreacchio
2,
Federico Canavese
3 and
Vito Pavone
1,*
1
Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy
2
Department of Pediatric Orthopedic Surgery, “V. Buzzi” Children Hospital, 20154 Milan, Italy
3
Pediatric Orthopedic Surgery Service, Hôpital Jeanne de Flandre, University of Lille, 59037 Lille, France
*
Author to whom correspondence should be addressed.
Children 2022, 9(3), 425; https://doi.org/10.3390/children9030425
Submission received: 12 February 2022 / Revised: 8 March 2022 / Accepted: 15 March 2022 / Published: 17 March 2022
(This article belongs to the Section Pediatric Orthopedics)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: Obesity in children is a clinical and social burden. The distal radius (DR) is the most common site of fractures in childhood and conservative treatment is widely used. Loss of reduction (LOR) is the major casting complication. The aim of this study is to evaluate obesity as a risk factor for LOR in children with displaced DR fractures (DRF) treated conservatively. Methods: 189 children under 16 years of age were treated conservatively for DRF. Patients were divided into three groups: normal weight (NW), overweight (OW) and obese (OB). The following radiographic criteria were evaluated in all patients: amount of initial translation (IT); quality of initial reduction; Cast (CI), Padding (PI), Canterbury (CaI), Gap (GI) and Three-Points (3PI) indices and the presence of LOR. Results: Statistically significant differences were found between the NW and the OB group for number of LOR (p = 0.002), severity (grade) of initial translation (p = 0.008), quality of initial reduction (p = 0.01) as well as CsI and CaI (p < 0.001). Conclusions: Obese children have a significantly higher rate of LOR compared to NW and OW children. A close follow-up is necessary in this population of patients. Preventive percutaneous pinning could be considered in older obese patients in order to reduce the need for further treatment.

1. Introduction

Obesity in childhood has become one of the most significant public health complications in numerous nations around the world [1], as it has led to the emergence of several grave obesity-related comorbidities [2,3]. In particular, both overweight and obese children have an altered cortical trabecular bone microarchitecture, which may increase their propensity to fracture following trauma [4]. In addition, recent research has highlighted the role played by leptin in altering the microstructural properties of bone in obese children, which may further increase the propensity to fracture in this subpopulation of patients [5]. Distal radius fractures (DRF) represent the most common type of fracture in children and account for 25% to 43% of all fractures in children [6,7,8]. According to Rana et al., obese patients tend to have a higher prevalence of traumatic limb lesions and a higher rate of operative treatment, despite the fact that cast treatment is the recommended treatment option in most cases [9]. On the other hand, open fractures, irreducible fractures, fractures with unacceptable alignment after attempted closed reduction, displaced intra-articular fractures, fractures with loss of reduction, as well as floating elbow injuries are candidates for surgical management [10].
Loss of reduction (LOR) is the most frequent complication in displaced DRF managed conservatively by closed reduction and casting (CRC) in children and adolescents [11]. LOR ranges from 21% to 47% and can be influenced by ‘fracture-related’ factors (displacement at fracture site, fracture obliquity and residual angulation after closed reduction) [12,13,14,15] and/or ‘surgeon-related’ factors, such as the Cast Index (CsI), the Padding Index (PI), the Canterbury Index (CAI), the Gap Index (GI) or the 3-points Index (3PI) [16,17,18,19,20,21]. In particular, PI, CAI, GI and 3PI have been shown to be optimal predictors of secondary displacement in children with DRF treated conservatively [22,23,24]. Other authors have reported that among ‘fracture-related’ factors, obesity enhances the risk of LOR after closed reduction in both DRF and forearm fractures in children and adolescents [22,23,24]. However, despite the findings of previous studies, the role of childhood obesity has not yet been clearly defined.
The aims of this study were (1) to evaluate obesity as a predictor of DRF pattern severity and of a low quality of fracture reduction in children; (2) to assess childhood obesity as a potential risk factor for secondary displacement in children with DRF treated conservatively by CRC; (3) to evaluate radiological parameters (CsI, PI, CAI, GI and 3PI) in different weight cohorts.
For obese DRF-affected children, a greater severity of fracture patterns, a lower quality of reduction, and greater difficulties in proper casting can be predicted

2. Materials and Methods

2.1. Sample Selection

Medical records of DRF-affected children under the age of 16 treated with closed reduction and long cast immobilization from January 2012 to December 2017 were reviewed retrospectively.
The inclusion criteria were as follows: (1) skeletal immaturity; (2) confirmed diagnosis of displaced DRF (>10° angulation on lateral radiographs; >20° angulation on AP radiographs; <50% apposition on AP or lateral radiographs); (3) chronological age under 16 years; (4) treatment at the emergency department as per the ‘treatment protocol’ described below; and (5) complete radiographic data.
Gender, age at the time of injury, mechanism of accident, involved side, height, weight, Body Mass Index (BMI), presence or absence of associated neurovascular injury and whether it was closed or open, as well as length of post-operative immobilization of all patients admitted to the emergency department were collected (Table 1). According to the WHO BMI-for-age criteria (5–19 years) [24], the sample was divided into 3 cohorts: normal weight (NW), overweight (OW) and obese (OB) [25,26] (Table 2).
Specifically, the OB group included patients with a BMI that was 2 or more standard deviations (SD) higher than that in the normal population (equivalent to a BMI of 30 kg/m2 at 19 years), while the OW group included patients with a BMI that was 1 SD higher than in the normal population (equivalent to a BMI of 25 kg/m2 at 19 years).
The WHO has published references for children and adolescents aged 5 to 19 and has suggested cut-off values for overweight and obesity based on z-scores [26]. WHO BMI-for-age standards are more precise than BMI in children due to their strict dependence on age and gender [25].

2.2. Treatment Protocol

The same experienced pediatric orthopedic surgical team treated all patients at the emergency department of our institution. Prior to closed reduction and cast immobilization, patients were administered equimolecular N2O2. A maximum of two attempts for a proper reduction were admitted before surgical treatment. After the reduction, a long arm cast was applied for 6 weeks, and the elbow was immobilized at 90–100° of flexion with the forearm in a neutral position.

2.3. Radiographic Evaluation

Radiographies of the injured forearm from the anteroposterior (AP) and lateral views, at 1, 2 and 4 weeks after reduction, were used to evaluate the fracture location, the direction and amount of displacement, as well as consolidation.
Radiographic standards for loss of reduction were defined as: <50% apposition on either radiograph, or >15° change on the lateral radiograph; >20° angulation on the lateral radiograph; and >10° angulation on the AP radiograph at the 1-week assessment [15]. According to the criteria of Mani et al. [15,27], the translations were classified as follows: grade I, no translation; grade II, translation <50%; grade III, translation >50%; and grade IV, complete loss of contact between fragments. According to the criteria proposed by Alemdaroglu et al., the quality of the initial reduction was divided in to (a) “anatomic reduction” without any remaining translation or angulation; (b) “good reduction” with less than 10° of residual dorsal angulation or 2 mm of residual translation; and (c) “fair reduction” with 10° to 20° residual angulation or a residual translation of 2–5 mm [15,28].
Moreover, the CsI, PI, CaI, GI, and 3PI were calculated for all subjects following conservative treatment.
On the AP radiographs at the level of the fracture site, the proportion between the inner diameter of the cast on lateral radiographs and the inner diameter of the cast was defined as the CsI; the risk of LOR is higher if the ratio is >0.7 [29].
On AP radiographs, the proportion between a) the inner cast to bone/skin distance on lateral radiographs and b) the maximum interosseous distance of the ratio was defined as the PI; the risk of LOR is higher if the ratio is >0.3 [30].
The summation of the CsI and PI results in the CaI; if the CaI is higher than 1.1, the risk of LOR is advanced [30].
The proportion between the inner plaster diameter on AP radiographs and lateral radiographs at the fracture site results in the GI; if the GI is higher than 0.15, the risk of LOR is advanced [31]. The 3PI takes into account the gap at the fracture site and the gap proximal and distal to the fracture; for values over 0.8, the risk of LOR is advanced [15].

2.4. Statistical Analysis

Continuous data are reported as means and standard deviations. In order to compare age means between the three cohorts of subjects, ANOVAs were performed. χ2-tests were used to evaluate the homogeneity of the three groups based on age, gender and laterality, and to compare the cut-off values of each index. Odds Ratios (OR) were used to calculate the risk factor for LOR. The selected threshold for statistical significance was p < 0.05. All statistical analyses were performed using 2016 GraphPad Software (GraphPad Inc., San Diego, CA, USA).

3. Results

3.1. Sample

In total, 189 (109 males; 80 females) out of 278 patients met the inclusion criteria and were enrolled in the trial.
The NW group contained 67 patients (35.5%; 38 boys, 29 girls) with a mean age of 11.6 ± 1.4 years at the time of injury (range, 10.2–14.9) and a mean WHO BMI-for-age of 0.8 ± 0.4 (range, 0.1–0.9); the OW group contained 84 patients (44.4%; 46 boys, 38 girls) with a mean age of 12.1 ± 2.3 years (range, 9.9–15.2) and a mean WHO BMI-for-age of 1.6 ± 0.5 (range 1.0–1.9); and the OB group contained 38 patients (20.1%; 25 boys, 13 girls) with a mean age of 11.3 ± 1.6 years (range 10.1–14.9) and a mean WHO BMI-for-age of 2.2 ± 0.2 (range 2.1–2.8). The three groups of patients did not differ significantly in their demographics (p > 0.05), except for WHO BMI-for-age (p < 0.05) (Table 1).

3.2. Radiographic Evaluation

Out of 189 patients, 41 (21.7%) had a LOR; of these, 23/41 (56.1%) required secondary surgical treatment (closed reduction and percutaneous pinning), while the remaining 18 underwent CRC again (43.9%).
The OR of secondary displacement was 0.44 (95% C.I.; 0.19–0.98) in the NW group, 0.86 (95% C.I.; 0.43–1.73) in the OW group, and 3.14 (95% C.I.; 1.44–6.81) in the OB group.
Statistically significant differences were found between the NW and the OB group for the number of LOR (p = 0.002), severity (grade) of initial translation (p = 0.008), and quality of initial reduction (p = 0.01). On the other hand, for NW and OW patients, the number of LOR, the severity of initial translation and the initial reduction quality were comparable (p > 0.05). There was a significant difference for the number of LOR between the OW and OB groups (p = 0.02) (Table 2).
According to the radiographic criteria, no statistically significant differences were found (p > 0.05) between the three groups of patients, except for the CsI between NW and OB patients (p < 0.00001) and between OW and OB patients (p = 0.001), and for the CAI between NW and OB patients (p = 0.001) and between OW and OB patients (p = 0.04) (Table 3).

4. Discussion

According to our findings, a worse initial translation and worse quality of closed reduction were recorded in conservatively treated DRF for the group of obese children compared to overweight children and children of normal weight. Moreover, obese children were shown to have a higher risk of LOR compared to overweight subjects and those of normal weight. This report also found that proper cast molding is more difficult in obese children and that this can potentially lead to LOR. Overall, only 12.2% of children required secondary surgical treatment and the majority of them were obese.
Childhood obesity is associated with multiple medical comorbidities, including several orthopedic conditions [32,33]; in addition, a strong correlation has been reported between fat mass and pediatric trauma, particularly for lower limb and forearm fractures [9]. A significant association of obesity with increased rates of open reduction internal fixation (ORIF) for distal radius and ulna fractures has been reported, and obese patients have also been shown to exhibit significant increases in complications after undergoing ORIF [34]. For these reasons, proper casting is mandatory, despite LOR following CRC being a relatively frequent complication of pediatric forearm and wrist fractures [10,15]. In a recent metanalysis, Vescio et al. [35] reported that the risk of LOR was four times higher in obese patients compared to subjects of normal weight.
Our data showed that 21.7% of patients had LOR, with 78% of cases being OW (17 out of 41; 41.5%) and OB patients (15 out of 41; 36.6%). In particular, the risk of LOR was 3.1 times higher for OB patients compared to the rest of the sample (OW and NW patients combined); 2.6 times higher (95% C.I.; 1.11–5.96) compared to the OW group, and 4.2 times higher (95% C.I.; 1.61–10.95) compared to the NW group. These findings are comparable to those reported by Okoroafor [23], DeFrancesco [24] and Liu et al. [33]. These findings are probably causally related to the large soft tissue envelope in obese children that makes it harder to maintain a stable reduction [15,23] (Figure 1).
It can be assumed that a lower reduction quality is related to a greater severity of initial translation.
Auer et al. reported that obese children with distal radius and forearm fractures tended to have a poorer quality of reduction and were at increased risk of LOR following CRC [22]. In our series, 42.1% of obese children had a fair reduction in the fracture.
We found that obese children had more severe initial translation compared to NW and OW patients (p = 0.008), as previously reported by Mani et al. [27]; the findings in children were comparable to those in adult patients [36,37]. This finding may be linked to the correlation between two key aspects, the surplus of fat mass and an amplified force applied to bone tissue at the time of injury.
In particular, an excess of fat mass has been shown to have a potentially detrimental effect on bone development in children [38], while an increased force applied to the skeleton increases the risk of fractures and the severity of displacement [34].
Both factors can interfere with proper fracture reduction, as the key components to achieve fracture stabilization with conservative treatment are proper cast molding, thin and uniform padding, and three-point fixation [13] (Figure 2).
In order to assess the effect of childhood obesity on the conservative treatment of DRF in children, we performed a radiological assessment of the major predictive indexes such as the CsI, PI, CAI, GI and 3PI. To the best of our knowledge, this is the first study to consider surgeon-related factors in overweight and obese patients from a radiological perspective and to compare them to children of normal weight. According to a recent study, the CsI, PI, and CAI were the predictive indexes most commonly used to estimate the risk of LOR in children with DRF treated conservatively [15].
According to our findings, NW, OW and OB patients showed no statistically significant differences for the PI and 3PI. On the other hand, according to the CsI and CAI, overweight and obese children had a higher incidence of inadequate cast molding compared to children with normal weight (p < 0.05). An abnormal proportion of the plaster diameter in the lateral and anteroposterior planes due to the excess of fat mass poorly affecting cast molding, lead to an amplified risk of LOR [13]. Hanstein et al. reported a weak positive correlation for distal radius fractures only (r = 0.171, p = 0.037) between the CsI and the BMI-for-age percentile [39].
The limitations of this study are its retrospective nature, the absence of clinical evaluation, the radiological follow-up being limited to the short term, and no long-term evaluations being performed. Moreover, there was possible bias regarding objectively measurable parameters.

5. Conclusions

In conclusion, long-arm casting represents a simple, safe, effective, and inexpensive option for the management of displaced DRF in children. However, obese children require proper cast molding even though it is more difficult to achieve compared to overweight and normal weight patients. As a consequence, obese children require close clinical and radiographic follow-ups [22]. Obesity should be considered as a negative predictive factor for the conservative treatment of DRF in children; in older obese children, percutaneous pinning could be considered as a primary treatment option.

Author Contributions

Conceptualization, A.V. and G.T.; methodology, A.V., F.C. and M.M.; software, A.V.; validation, G.T., V.P. and A.A.; formal analysis, A.V. and F.C.; investigation, M.S.; resources, A.V.; data curation, A.C.; writing—original draft preparation, A.V.; writing—review and editing, F.C. and G.T.; visualization, V.P. and A.A.; supervision, V.P.; project administration, V.P.; funding acquisition, V.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Ethical review and approval were waived for this study, due to retrospective nature of the study.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Kumar, S.; Kelly, A.S. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clin. Proc. 2017, 92, 251–265. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Dietz, W.H.; Robinson, T.N. Overweight Children and Adolescents. N. Engl. J. Med. 2005, 352, 2100–2109. [Google Scholar] [CrossRef] [Green Version]
  3. Pavone, V.; Vescio, A.; Canavese, F.; Costa, D.; Sessa, G.; Testa, G. Effects of Body Weight on the Clinical and Radiological Outcomes of Children with Flexible Flatfeet Managed with the ‘Calcaneo-Stop’Procedure. J. Pediatr. Orthop. B 2019, 28, 228–234. [Google Scholar] [CrossRef]
  4. Kindler, J.M.; Pollock, N.K.; Ross, H.L.; Modlesky, C.M.; Singh, H.; Laing, E.M.; Lewis, R.D. Obese Versus Normal-Weight Late-Adolescent Females Have Inferior Trabecular Bone Microarchitecture: A Pilot Case-Control Study. Calcif. Tissue Int. 2017, 101, 479–488. [Google Scholar] [CrossRef] [PubMed]
  5. Dimitri, P.; Jacques, R.M.; Paggiosi, M.; King, D.; Walsh, J.; Taylor, Z.A.; Frangi, A.F.; Bishop, N.; Eastell, R. Leptin May Play a Role in Bone Microstructural Alterations in Obese Children. J. Clin. Endocrinol. Metab. 2015, 100, 594–602. [Google Scholar] [CrossRef] [PubMed]
  6. Naranje, S.M.; Erali, R.A.; Warner, W.C.; Sawyer, J.R.; Kelly, D.M. Epidemiology of Pediatric Fractures Presenting to Emergency Departments in the United States. J. Pediatr. Orthop. 2016, 36, e45–e48. [Google Scholar] [CrossRef]
  7. Joeris, A.; Lutz, N.; Blumenthal, A.; Slongo, T.; Audigé, L. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). Acta Orthop. 2017, 88, 123–128. [Google Scholar] [CrossRef] [Green Version]
  8. Dua, K.; Abzug, J.M.; Sesko Bauer, A.; Cornwall, R.; Wyrick, T.O. Pediatric Distal Radius Fractures. Instr. Course Lect. 2017, 66, 447–460. [Google Scholar]
  9. Rana, A.R.; Michalsky, M.P.; Teich, S.; Groner, J.I.; Caniano, D.A.; Schuster, D.P. Childhood Obesity: A Risk Factor for Injuries Observed at a Level-1 Trauma Center. J. Pediatr. Surg. 2009, 44, 1601–1605. [Google Scholar] [CrossRef] [Green Version]
  10. Grenier, G.; Samora, J.B. What Is New in Pediatric Wrist Fractures? Oper. Tech. Orthop. 2019, 29, 55–66. [Google Scholar] [CrossRef]
  11. Crawford, S.N.; Lee, L.S.K.; Izuka, B.H. Closed Treatment of Overriding Distal Radial Fractures without Reduction in Children. JBJS J. Bone Jt. Surg. 2012, 94, 246–252. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  12. Asadollahi, S.; Ooi, K.S.; Hau, R.C. Distal Radial Fractures in Children: Risk Factors for Redisplacement Following Closed Reduction. J. Pediatr. Orthop. 2015, 35, 224–228. [Google Scholar] [CrossRef] [PubMed]
  13. McQuinn, A.G.; Jaarsma, R.L. Risk Factors for Redisplacement of Pediatric Distal Forearm and Distal Radius Fractures. J. Pediatr. Orthop. 2012, 32, 687–692. [Google Scholar] [CrossRef] [PubMed]
  14. Arora, R.; Mishra, P.; Aggarwal, A.N.; Anshuman, R.; Sreenivasan, R. Factors Responsible for Redisplacement of Pediatric Forearm Fractures Treated by Closed Reduction and Cast. Indian J. Orthop. 2018, 52, 536–547. [Google Scholar] [CrossRef]
  15. Pavone, V.; Vescio, A.; Lucenti, L.; Chisari, E.; Canavese, F.; Testa, G. Analysis of Loss of Reduction as Risk Factor for Additional Secondary Displacement in Children with Displaced Distal Radius Fractures Treated Conservatively. Orthop. Traumatol. Surg. Res. 2020, 106, 193–198. [Google Scholar] [CrossRef]
  16. Pretell Mazzini, J.; Rodriguez Martin, J. Paediatric Forearm and Distal Radius Fractures: Risk Factors and Re-Displacement—Role of Casting Indices. Int. Orthop. 2010, 34, 407–412. [Google Scholar] [CrossRef] [Green Version]
  17. Proctor, M.T.; Moore, D.J.; Paterson, J.M. Redisplacement after Manipulation of Distal Radial Fractures in Children. J. Bone Jt. Surg. Br. 1993, 75, 453–454. [Google Scholar] [CrossRef]
  18. Gibbons, C.L.; Woods, D.A.; Pailthorpe, C.; Carr, A.J.; Worlock, P. The Management of Isolated Distal Radius Fractures in Children. J. Pediatr. Orthop. 1994, 14, 207–210. [Google Scholar] [CrossRef]
  19. McLauchlan, G.J.; Cowan, B.; Annan, I.H.; Robb, J.E. Management of Completely Displaced Metaphyseal Fractures of the Distal Radius in Children. J. Bone Jt. Surg. Br. 2002, 84-B, 413–417. [Google Scholar] [CrossRef]
  20. Marcheix, P.-S.; Peyrou, P.; Longis, B.; Moulies, D.; Fourcade, L. Dorsal Distal Radius Fractures in Children: Role of Plaster in Redisplacement of These Fractures. J. Pediatr. Orthop. B 2011, 20, 372–375. [Google Scholar] [CrossRef]
  21. Ghimire, N.; Uprety, S.; Lamichhane, A. Risk Factors for Redisplacement in Pediatric Distal Radius Fractures after Closed Reduction and Cast Immobilisation. J. Inst. Med. 2016, 40, 81–84. [Google Scholar]
  22. Auer, R.T.; Mazzone, P.; Robinson, L.; Nyland, J.; Chan, G. Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures. J. Pediatr. Orthop. 2016, 36, e86–e88. [Google Scholar] [CrossRef] [PubMed]
  23. Okoroafor, U.C.; Cannada, L.K.; McGinty, J.L. Obesity and Failure of Nonsurgical Management of Pediatric Both-Bone Forearm Fractures. J. Hand Surg. 2017, 42, 711–716. [Google Scholar] [CrossRef] [PubMed]
  24. DeFrancesco, C.J.; Rogers, B.H.; Shah, A.S. Obesity Increases Risk of Loss of Reduction after Casting for Diaphyseal Fractures of the Radius and Ulna in Children: An Observational Cohort Study. J. Orthop. Trauma 2018, 32, e46–e51. [Google Scholar] [CrossRef]
  25. De Onis, M.; Lobstein, T. Defining Obesity Risk Status in the General Childhood Population: Which Cut-Offs Should We Use? Int. J. Pediatr. Obes. 2010, 5, 458–460. [Google Scholar] [CrossRef]
  26. Group, W.M.G.R.S.; de Onis, M. Assessment of Differences in Linear Growth among Populations in the WHO Multicentre Growth Reference Study. Acta Paediatr. 2006, 95, 56–65. [Google Scholar]
  27. Mani, G.V.; Hui, P.W.; Cheng, J.C. Translation of the Radius as a Predictor of Outcome in Distal Radial Fractures of Children. J. Bone Jt. Surg. Br. 1993, 75, 808–811. [Google Scholar] [CrossRef]
  28. Alemdaroglu, K.B.; Iltar, S.; Çimen, O.; Uysal, M.; Alagöz, E.; Atlihan, D. Risk Factors in Redisplacement of Distal Radial Fractures in Children. JBJS J. Bone Jt. Surg. 2008, 90, 1224–1230. [Google Scholar] [CrossRef] [Green Version]
  29. Chess, D.G.; Hyndman, J.C.; Leahey, J.L.; Brown, D.C.S.; Sinclair, A.M. Short Arm Plaster Cast for Distal Pediatric Forearm Fractures. J. Pediatr. Orthop. 1994, 14, 211–213. [Google Scholar] [CrossRef]
  30. Bhatia, M.; Housden, P.H. Redisplacement of Paediatric Forearm Fractures: Role of Plaster Moulding and Padding. Injury 2006, 37, 259–268. [Google Scholar] [CrossRef]
  31. Malviya, A.; Tsintzas, D.; Mahawar, K.; Bache, C.E.; Glithero, P.R. Gap Index: A Good Predictor of Failure of Plaster Cast in Distal Third Radius Fractures. J. Pediatr. Orthop. B 2007, 16, 48–52. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  32. Gettys, F.K.; Jackson, J.B.; Frick, S.L. Obesity in Pediatric Orthopaedics. Orthop. Clin. 2011, 42, 95–105. [Google Scholar] [CrossRef] [PubMed]
  33. Donati, F.; Costici, P.F.; De Salvatore, S.; Burrofato, A.; Micciulli, E.; Maiese, A.; Santoro, P.; La Russa, R. A Perspective on Management of Limb Fractures in Obese Children: Is It Time for Dedicated Guidelines? Front. Pediatr. 2020, 8, 207. [Google Scholar] [CrossRef] [PubMed]
  34. Li, N.Y.; Cruz, A., Jr.; Kalagara, S.; Hersey, A.; Daniels, A. The Influence of Obesity on the Operative and Non-Operative Management of Pediatric Extremity Fractures. Pediatrics 2019, 144, 805. [Google Scholar] [CrossRef]
  35. Vescio, A.; Testa, G.; Montemagno, M.; Sapienza, M.; Pavone, V. Secondary Displacement Risk after Reduction and Cast Immobilization of Displaced Distal Radius Fractures in Overweight and Obese Children: A Systematic Review and Meta-Analysis. Minerva 2021, 72, 71–76. [Google Scholar] [CrossRef]
  36. Liu, Y.; Liu, C.; Guo, D.; Wang, N.; Zhao, Y.; Li, D. Effect of Childhood Overweight on Distal Metaphyseal Radius Fractures Treated by Closed Reduction. J. Orthop. Surg. 2021, 16, 182. [Google Scholar] [CrossRef] [PubMed]
  37. Testa, G.; Vescio, A.; Di Masi, P.; Bruno, G.; Sessa, G.; Pavone, V. Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years. J. Funct. Morphol. Kinesiol. 2019, 4, 26. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  38. Dimitri, P. Fat and Bone in Children–Where Are We Now? Ann. Pediatr. Endocrinol. Metab. 2018, 23, 62. [Google Scholar] [CrossRef]
  39. Hanstein, R.; Otsuka, N.Y.; Marano, G.; Burton, D.A.; Qiu, X.; Schulz, J.F.; Gomez, J.A. Body Mass Index Does Not Affect Cast Index but Increases Risk of Complication Associated with Treatment of Distal Forearm Fractures. Pediatrics 2019, 144, 815. [Google Scholar] [CrossRef]
Children 09 00425 g001 550
Figure 1. A comparison of the lateral view of the fat layer (red lines) at a fracture site (green lines) between (a) an obese patient and (b) a patient of normal weight matched for age and gender.
Figure 1. A comparison of the lateral view of the fat layer (red lines) at a fracture site (green lines) between (a) an obese patient and (b) a patient of normal weight matched for age and gender.
Children 09 00425 g001
Children 09 00425 g002a 550Children 09 00425 g002b 550
Figure 2. Case report of an obese patient. (a) Post-reduction casting X-ray; (b) one-week post-reduction X-ray with loss of reduction; (c) surgical treatment of the fracture.
Figure 2. Case report of an obese patient. (a) Post-reduction casting X-ray; (b) one-week post-reduction X-ray with loss of reduction; (c) surgical treatment of the fracture.
Children 09 00425 g002aChildren 09 00425 g002b
Table
Table 1. Patients’ characteristics.
Table 1. Patients’ characteristics.
GroupPatientsMFWHO
BMI-for-Age		Mean AgeSide
RightLeft
Sample189109801.4 ± 0.411.8 ± 1.812861
NW6738290.8 ± 0.411.6 ± 1.44522
OW8446381.6 ± 0.512.1 ± 2.35925
OB3825152.2 ± 0.211.3 ± 1.62414
Table
Table 2. Loss of reduction (LOR), grade of initial translation, and quality of initial reduction for each cohort.
Table 2. Loss of reduction (LOR), grade of initial translation, and quality of initial reduction for each cohort.
GroupLORGrade of Initial TranslationQuality of Initial Reduction
NoYes1234AnatomicGoodFair
Sample148(78.3)41(21.7)44(23.3)55(29.1)57(30.1)33(17.5)57(78.3)80(78.3)52(78.3)
NW58(78.3)9(78.3)23(78.3)21(78.3)16(78.3)7(78.3)26(78.3)30(78.3)11(78.3)
OW67(78.3)17(78.3)16(78.3)26(78.3)28(78.3)14(78.3)22(78.3)37(78.3)25(78.3)
OB23(78.3)15(78.3)5(78.3)8(78.3)13(78.3)12(78.3)9(78.3)13(78.3)16(78.3)
Table
Table 3. Radiological indices for each cohort.
Table 3. Radiological indices for each cohort.
Cast IndexPadding IndexCanterbury IndexGap IndexThree-Point Index
(Cutoff/Tot)(Cutoff/Tot)(Cutoff/Tot)(Cutoff/Tot)(Cutoff/Tot)
NW Group45/67
(67.2%)		52/67
(77.6%)		48/67
(71.6%)		38/67
(56.7%)		43/67
(64.2%)
p NW vs. OW0.060.480.510.810.87
OW Group 54/84
(64.3%)		61/84
(72.6%)		56/84
(66.7%)		46/84
(54.8%)		55/84
(65.5%)
p OW vs. OB0.0010.440.040.870.80
OB Group12/38
(31.6%)		25/38
(65.8%)		18/38
(47.4%)		20/38
(52.6%)		24/38
(63.2%)
p NW vs. OB<0.000010.190.010.690.92
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Vescio, A.; Testa, G.; Sapienza, M.; Caldaci, A.; Montemagno, M.; Andreacchio, A.; Canavese, F.; Pavone, V. Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively? Children 2022, 9, 425. https://doi.org/10.3390/children9030425

AMA Style

Vescio A, Testa G, Sapienza M, Caldaci A, Montemagno M, Andreacchio A, Canavese F, Pavone V. Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively? Children. 2022; 9(3):425. https://doi.org/10.3390/children9030425

Chicago/Turabian Style

Vescio, Andrea, Gianluca Testa, Marco Sapienza, Alessia Caldaci, Marco Montemagno, Antonio Andreacchio, Federico Canavese, and Vito Pavone. 2022. "Is Obesity a Risk Factor for Loss of Reduction in Children with Distal Radius Fractures Treated Conservatively?" Children 9, no. 3: 425. https://doi.org/10.3390/children9030425

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop