The Role of Obesity on Cast Index and Secondary Intervention in Pediatric Forearm Fractures
Journal Title: Journal of Orthopaedic Science and Research - Year 2020, Vol 1, Issue 1
Abstract
Background: Pediatric forearm fractures are common, and the majority are treated with closed reduction and immobilization. Additionally, the incidence of pediatric obesity is rising. Cast index is a useful metric to assess the quality of a cast mold. This study aims to assess the effect of obesity in obtaining an adequate cast index as a predictor for fracture redisplacement and risk for subsequent intervention after a reduction. Methods: A retrospective chart review was conducted over a six-year time period on children with a displaced/unstable forearm fracture that underwent reduction and molded long arm casting with >4 weeks follow-up. The cast index was measured on immediate postmanipulation radiographs. Children were divided into three groups according to body mass index (BMI) percentile for age: Underweight (<5th); Normal BMI (5th-85th); Overweight/obese (≥ 85th). Clinical notes and radiographs were reviewed for loss of reduction and secondary intervention. Results: 84 patients (70% male) qualified for inclusion. Mean age was 7.4 years (Range 3-14 years). Fracture redisplacement and secondary intervention occurred in 8 patients (9.5%). Patient BMI distribution was 5% in the Underweight, 71% in the Normal BMI and 24% in the Overweight/obese groups. The mean cast index in the 8 patients who required a second procedure was significantly higher than those who did not (1.00±0.06 vs 0.83±0.07, P<.001). The mean cast index among the underweight, normal BMI and overweight/obese groups was not statistically different. Obesity was not an independent risk factor for secondary intervention. Regression analysis did not correlate increasing cast index with BMI percentile for age. Conclusion: Cast index continues to be reliable metric for evaluating the quality of the cast mold and loss of subsequent reduction. In this cohort, it does not appear that BMI plays a significant role in hindering the ability to place a well-molded cast. Level of Evidence: Prognostic level IV
Authors and Affiliations
Kathy M McGurk*, Ted Samaddar, William R Barfield, Robert F Murphy
Keywords
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- EP ID EP698808
- DOI http://dx.doi.org/10.46889/JOSR.2020.1103
- Views 81
- Downloads 0
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