Department of Pediatric Orthopedics, Rady Children's Hospital and Health Center, San Diego, CA 92123, USA.
Clin Orthop Relat Res. 2013 Apr;471(4):1193-8. doi: 10.1007/s11999-012-2566-2.
Obese children reportedly have an increased risk of sustaining musculoskeletal injuries compared with their normal-weight peers. Obese children are at greater risk for sustaining fractures of the forearm, particularly from low-energy mechanisms. Furthermore, obesity is a risk factor for sustaining an extremity fracture requiring surgery. However, it is unclear what role obesity plays in fractures about the distal humerus.
QUESTIONS/PURPOSES: We therefore asked whether (1) children who sustain lateral condyle (LC) fractures have a higher body mass index (BMI) as compared with those with supracondylar (SC) humerus fractures; and (2) children with a higher BMI sustain more severe fractures regardless of fracture pattern.
We retrospectively reviewed 992 patients: 230 with LC injuries and 762 with SC fractures. We determined BMI and BMI-for-age percentiles. Fracture types were classified by the systems proposed by Weiss et al. (LC fractures) and Wilkins (SC fractures).
The LC group had both a higher mean BMI and BMI-for-age percentile than the SC group as well as had more obese patients (37% versus 19%). Within the LC group, children with Type 3 fractures had a higher BMI that those with Type 1 fractures (19 versus 17). There was a higher percentage of obese patients with Type 3 LC fractures compared with Type 1 and 2 fractures (44% versus 27% and 26%). Among patients with SC fractures, there was no difference among the BMI, BMI-for-age percentiles, or percentage of obese children when analyzed by fracture subtype.
Obesity places a child at greater risk for sustaining a LC fracture and when these fractures occur, they are often more severe injuries compared with those in nonobese children.
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
据报道，肥胖儿童发生肌肉骨骼损伤的风险高于正常体重儿童。肥胖儿童前臂骨折的风险更高，尤其是低能量机制引起的骨折。此外，肥胖是需要手术治疗的四肢骨折的危险因素。然而，肥胖在肱骨远端骨折中起什么作用尚不清楚。
问题/目的：因此，我们想知道：（1）与髁上骨折相比，发生外侧髁骨折的儿童的体重指数（BMI）是否更高；以及（2）无论骨折类型如何，BMI 较高的儿童是否会发生更严重的骨折。
我们回顾性分析了 992 名患者：230 名发生外侧髁损伤，762 名发生髁上骨折。我们确定了 BMI 和 BMI 年龄百分位数。骨折类型按 Weiss 等人提出的系统（外侧髁骨折）和 Wilkins（髁上骨折）进行分类。
外侧髁组的平均 BMI 和 BMI 年龄百分位数均高于髁上组，肥胖患者也更多（37%比 19%）。在外侧髁组中，III 型骨折患儿的 BMI 高于 I 型骨折患儿（19 比 17）。III 型外侧髁骨折患儿肥胖的比例高于 I 型和 II 型骨折患儿（44%比 27%和 26%）。在髁上骨折患儿中，当按骨折亚型分析时，BMI、BMI 年龄百分位数或肥胖患儿的比例均无差异。
肥胖使儿童更容易发生外侧髁骨折，而且当这些骨折发生时，与非肥胖儿童相比，往往是更严重的损伤。
II 级，预后研究。有关证据水平的完整描述，请参见作者指南。
