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Surgical Treatment of Femoral Fractures in Obese Children: Does Excessive Body Weight Increase the Rate of Complications?

¹ Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, Room 5255 (A.I.L. and C.P.P.) and Room 5253 (M.C.A.), Baltimore, MD 21287-0882. E-mail address for A.I. Leet: aleet1{at}jhmi.edu

Investigation performed at the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: A retrospective review of the charts of children between six and fourteen years of age who were treated operatively for a femoral shaft fracture was performed, and complications were identified.

Results: One hundred and three children (104 fractures), with a mean age at the time of injury of 9.3 years, were identified. Fifty-nine fractures were treated with external fixation, and forty-five were treated with an intramedullary rod. Six children (6%) were considered obese, with a weight for age at the 95th percentile or higher. An additional four children were extremely heavy at the 90th to the 94th percentile of weight for age. Three complications occurred in the six obese children, and one complication occurred in the four extremely heavy children. Eleven (12%) of the remaining ninety-three children had a complication. When examined according to treatment groups, the complication rate for heavier children was higher for both the group managed with an intramedullary rod and the group that had external fixation (p = 0.004).

Conclusions: Obese children have an increased rate of postoperative complications compared with children who are not obese. Therefore, parents of obese children should be warned that such children may have a potentially increased risk of complications associated with surgical management of a femoral fracture.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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