Gilbert Shawn R, MacLennan Paul A, Backstrom Ian, Creek Aaron, Sawyer Jeffrey
*Department of Surgery, University of Alabama at Birmingham, Birmingham, AL; †University of Tennessee Campbell Clinic, Memphis, TN; and ‡Department of Orthopaedic Surgery, University of Tennessee Campbell Clinic, Memphis, TN.
J Orthop Trauma. 2015 Jan;29(1):e12-7. doi: 10.1097/BOT.0000000000000132.
To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.
Prognostic study, retrospective chart review.
Two level I pediatric trauma centers.
The trauma registries of 2 pediatric hospitals were queried for patients with lower extremity long-bone fractures resulting from blunt trauma. 2858 alerts were examined, and 397 patients had lower extremity fractures. Three hundred thirty-one patients with a total of 394 femur or tibia fractures met the inclusion criteria, and 70 patients (21%) were obese.
Weight for age >95th percentile was defined as obese. Radiographs were reviewed, and fractures were classified according the OTA/AO pediatric fracture classification system. Fracture patterns (OTA subsegment), severity, and choice of intervention for femur fractures were the primary outcomes.
Overall, obese patients were twice as likely [risk ratio (RR), 2.20; 95% confidence interval (CI), 1.25-3.89] to have fractures involving the physis. Physeal fracture risk was greater for femur fractures (RR, 3.25; 95% CI, 1.35-7.78) than tibia fractures (RR, 1.58; 95% CI, 0.76-3.26). Severity did not differ between groups. Obese patients with femur fractures were more likely to be treated with locked nails.
Obese pediatric trauma patients are more likely to sustain fractures involving the physis than nonobese patients. This could be related to intrinsic changes to the physis related to obesity or altered biomechanical forces. This is consistent with the observed relationships between obesity and other conditions affecting the physis including Blount disease and slipped capital femoral epiphysis.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定肥胖与非肥胖儿科创伤患者的骨折类型及股骨骨折治疗选择是否存在差异。
预后研究，回顾性病历审查。
两家一级儿科创伤中心。
查询了两家儿科医院的创伤登记处，以获取因钝性创伤导致下肢长骨骨折的患者信息。共检查了2858条警报，其中397例患者有下肢骨折。331例共有394处股骨或胫骨骨折的患者符合纳入标准，70例患者（21%）为肥胖患者。
年龄体重>第95百分位数定义为肥胖。复查X线片，并根据OTA/AO儿科骨折分类系统对骨折进行分类。骨折类型（OTA亚段）、严重程度及股骨骨折的干预选择为主要观察结果。
总体而言，肥胖患者发生涉及骨骺的骨折的可能性是正常患者的两倍[风险比（RR），2.20；95%置信区间（CI），1.25 - 3.89]。股骨骨折的骨骺骨折风险（RR，3.25；95%CI，1.35 - 7.78）高于胫骨骨折（RR，1.58；95%CI，0.76 - 3.26）。两组之间的严重程度无差异。肥胖股骨骨折患者更有可能接受锁定髓内钉治疗。
肥胖儿科创伤患者比非肥胖患者更易发生涉及骨骺的骨折。这可能与肥胖相关的骨骺内在变化或生物力学力改变有关。这与肥胖与其他影响骨骺的疾病（包括Blount病和股骨头骨骺滑脱）之间的观察关系一致。
预后II级。有关证据级别的完整描述，请参阅《作者须知》。
