Obese Adolescents Have Higher Risk for Severe Lower Extremity Fractures After Falling

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2023 Jul 19

PMID 37466766

Authors

Nicolas Gonzalez

Jeffry Nahmias

Sebastian Schubl

Lourdes Swentek

Brian R Smith

Ninh T Nguyen

Areg Grigorian

Affiliations

Soon will be listed here.

Abstract

Introduction: Reports vary on the impact of obesity on the incidence of lower extremity fractures after a fall. We hypothesized that obese adolescents (OA) presenting after a fall have a higher risk of any and severe lower extremity fractures compared to non-OAs.

Methods: A national database was queried for adolescents (12-17 years old) after a fall. Primary outcome included lower extremity fracture. Adolescents with a body mass index (BMI) ≥ 30 (OA) were compared to adolescents with a BMI < 30 (non-OA).

Results: From 20,264 falls, 2523 (12.5%) included OAs. Compared to non-OAs, the rate of any lower extremity fracture was higher for OAs (51.5% vs. 30.7%, p < 0.001). This remained true for lower extremity fractures at all locations (all p < 0.05). After adjusting for sex and age, associated risk for any lower extremity fracture (OR 2.41, CI 2.22-2.63, p < 0.001) and severe lower extremity fracture (OR 1.31, CI 1.15-1.49, p < 0.001) was higher for OAs. This remained true in subset analyses of ground level falls (GLF) and falls from height (FFH) (all p < 0.05).

Conclusions: Obesity significantly impacts adolescents' risk of all types of lower extremity fractures after FFH or GLF. Hence, providers should have heightened awareness for possible lower extremity fractures in OAs.

Level Of Evidence: IV.

Citing Articles

Influences of cognitive load on center of pressure trajectory of young male adults with excess weight during gait initiation.

Kong L, Zhang Z, Bao J, Zhu X, Tan Y, Xia X Front Bioeng Biotechnol. 2024; 11:1297068.

PMID: 38249798 PMC: 10796550. DOI: 10.3389/fbioe.2023.1297068.

References

Fintini D, Cianfarani S, Cofini M, Andreoletti A, Ubertini G, Cappa M . The Bones of Children With Obesity. Front Endocrinol (Lausanne). 2020; 11:200. PMC: 7193990. DOI: 10.3389/fendo.2020.00200. View

Cao J . Effects of obesity on bone metabolism. J Orthop Surg Res. 2011; 6:30. PMC: 3141563. DOI: 10.1186/1749-799X-6-30. View

Modig K, Erdefelt A, Mellner C, Cederholm T, Talback M, Hedstrom M . "Obesity Paradox" Holds True for Patients with Hip Fracture: A Registry-Based Cohort Study. J Bone Joint Surg Am. 2019; 101(10):888-895. DOI: 10.2106/JBJS.18.01249. View

Fornari E, Suszter M, Roocroft J, Bastrom T, Edmonds E, Schlechter J . Childhood obesity as a risk factor for lateral condyle fractures over supracondylar humerus fractures. Clin Orthop Relat Res. 2012; 471(4):1193-8. PMC: 3586017. DOI: 10.1007/s11999-012-2566-2. View

Nhan D, Leet A, Lee R . Associations of childhood overweight and obesity with upper-extremity fracture characteristics. Medicine (Baltimore). 2021; 100(18):e25302. PMC: 8104144. DOI: 10.1097/MD.0000000000025302. View

Shultz S, Anner J, Hills A . Paediatric obesity, physical activity and the musculoskeletal system. Obes Rev. 2009; 10(5):576-82. DOI: 10.1111/j.1467-789X.2009.00587.x. View

Kessler J, Koebnick C, Smith N, Adams A . Childhood obesity is associated with increased risk of most lower extremity fractures. Clin Orthop Relat Res. 2012; 471(4):1199-207. PMC: 3586019. DOI: 10.1007/s11999-012-2621-z. View

Tay-Lasso E, Grigorian A, Lekawa M, Dolich M, Schubl S, Barrios C . Obesity Does Not Increase Risk for Mortality in Severe Sepsis Trauma Patients. Am Surg. 2022; 89(11):4734-4739. DOI: 10.1177/00031348221078986. View

Nantel J, Brochu M, Prince F . Locomotor strategies in obese and non-obese children. Obesity (Silver Spring). 2006; 14(10):1789-94. DOI: 10.1038/oby.2006.206. View

10.

Shafi S, Nathens A, Cryer H, Hemmila M, Pasquale M, Clark D . The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma. J Am Coll Surg. 2009; 209(4):521-530.e1. DOI: 10.1016/j.jamcollsurg.2009.07.001. View

11.

Brahmbhatt T, Hernon M, Siegert C, Plauche L, Young L, Burke P . Trauma and BMI Mortality. Curr Obes Rep. 2017; 6(2):211-216. DOI: 10.1007/s13679-017-0264-9. View

12.

McGregor P, Lyons M, Wozniak A, Linko K, Fishman F, Cappello T . The Effect of Obesity on Pediatric Tibia Fractures. Iowa Orthop J. 2022; 42(1):41-46. PMC: 9210421. View

13.

Covarrubias J, Grigorian A, Schubl S, Gambhir S, Dolich M, Lekawa M . Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy. Eur J Trauma Emerg Surg. 2020; 47(5):1561-1568. PMC: 7222077. DOI: 10.1007/s00068-020-01329-w. View

14.

Dvorak J, Lester E, Maluso P, Tatebe L, Schlanser V, Kaminsky M . The Obesity Paradox in the Trauma Patient: Normal May not Be Better. World J Surg. 2020; 44(6):1817-1823. PMC: 7222933. DOI: 10.1007/s00268-020-05398-1. View

15.

Adams A, Kessler J, Deramerian K, Smith N, Black M, Porter A . Associations between childhood obesity and upper and lower extremity injuries. Inj Prev. 2012; 19(3):191-7. PMC: 3747966. DOI: 10.1136/injuryprev-2012-040341. View

16.

Li N, Kalagara S, Hersey A, Eltorai A, Daniels A, Cruz Jr A . Impact of obesity on operative treatment and inpatient outcomes of paediatric limb fractures. Bone Joint J. 2019; 101-B(4):491-496. DOI: 10.1302/0301-620X.101B4.BJJ-2018-0740.R2. View

17.

Donati F, Costici P, De Salvatore S, Burrofato A, Micciulli E, Maiese A . A Perspective on Management of Limb Fractures in Obese Children: Is It Time for Dedicated Guidelines?. Front Pediatr. 2020; 8:207. PMC: 7225297. DOI: 10.3389/fped.2020.00207. View

18.

Arbabi S, Wahl W, Hemmila M, Kohoyda-Inglis C, Taheri P, Wang S . The cushion effect. J Trauma. 2003; 54(6):1090-3. DOI: 10.1097/01.TA.0000064449.11809.48. View

19.

Kim S, Ahn J, Kim H, Kim J . Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Paediatr. 2016; 105(10):1152-7. DOI: 10.1111/apa.13343. View

20.

Liu Q, Wu M, Orgill D, Bai X, Panayi A . The effect of obesity on inpatient outcomes in lower extremity trauma: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2021; 92(2):464-470. DOI: 10.1097/TA.0000000000003328. View