Obesity increases postop complication risk in pediatric fracture patients

Half of obese children treated for femoral shaft fractures had a postop complication compared to 12% of nonobese children.

Obesity significantly increases children’s risks for serious complications following surgery for femoral shaft fractures, a new study by Johns Hopkins University researchers shows.

“Similar to obese adults, obese children have an increased rate of complications after orthopedic procedures compared with those who are not obese,” the authors said in the study, noting complications mainly involved the wound and fracture site failure.

“In order to improve the outcome ... it may be necessary to pay more meticulous attention to wounds in such patients or to leave external fixation in place until abundant callus formation is evident,” the study authors added.

Weight data from anesthetic records

Arabella I. Leet, MD, and colleagues at the Johns Hopkins Hospital’s department of orthopedic surgery retrospectively reviewed the charts of 103 pediatric patients treated for 104 femoral shaft fractures over a seven-year period. This included 16 open and 88 closed fractures. All patients were between 6 and 14 years old (mean age, 9.3 years) at the time of the fracture. Follow-up averaged 6.3 months.

The hospital normally obtains weight information for children undergoing surgery from parents’ estimates. Because of this imprecision, the researchers instead used anesthetic records to determine weight data. These data had been charted using the standard pediatric weight-for-age charts provided by the Centers for Disease Control and Prevention (CDC).

Using CDC criteria, the researchers considered a child obese if his or her weight was in the 95th percentile or higher than the norm for the entire pediatric population. Children weighing greater than the 90th percentile were considered extremely heavy, according to the study.

Five pediatric orthopedic surgeons treated all fractures according to their own preferences, using external fixation for 59 fractures and internal fixation for 45 fractures.

The data analysis only involved complications important enough to require hospitalization or additional surgery, the authors noted. “Thus, minor problems, such as a draining pin requiring only oral antibiotic treatment, were not considered to be a complication for ... our analysis,” they said.

Obesity increases complications

Six (6%) children were considered obese and four were considered extremely heavy. Among obese children, three patients experienced postop complications, which included one refracture and two wound problems, according to the study.

“As half of the obese children had a complication, the rate of complications for those children was significantly higher (P=.004) than that for the nonobese children (11 of 93 patients, 12%),” the authors said.

One of the four children characterized as extremely heavy had a complication. This child, who had been treated with external fixation, developed a pin tract infection requiring bone debridement and pin removal, according to the study.

A secondary analysis grouping children according to fracture management also found higher complication rates for overweight children.

Among the 59 children managed with external fixation, two of four extremely heavy or obese patients had complications. In comparison, only seven of the remaining 55 normal-weight children experienced complications (P=.02).

The researchers found similar results among the 45 children treated with an intramedullary rod. For these children, again, two of four overweight children experienced complications compared with four of the remaining 41 (10%) normal children (P=.02), according to the study.

“Because the complication rate after surgery is greater for obese children, parents should be warned before surgery about the increased risks associated with the treatment of a femoral fracture in an obese child,” the authors said.

For more information:
Leet AI, Pichard CP, Ain MC. Surgical treatment of femoral fractures in obese children: does excessive body weight increase the rate of complications? J Bone Joint Surg Am. 2005;87-A:2609-2613.