A Perspective on Management of Limb Fractures in Obese Children: Is It Time for Dedicated Guidelines?

Fabrizio Donati, Pier Francesco Costici, Sergio De Salvatore, Aaron Burrofato, Enrico Micciulli, Aniello Maiese, Paola Santoro, Raffaele La Russa

Research output: Contribution to journalArticlepeer-review

Abstract

Limb fractures are the most common injuries in pediatric orthopedics. Early and late complications are often not preventable, even when providing the best treatment; furthermore, these injuries are largely implicated in medico-legal claims. The development of evidence-based guidelines is one of the main goals of medical research. Approved guidelines for diagnosis, treatment, and follow up are fundamental to obtain the best results in medical practice. Guidelines in pediatric traumatology have been developed, even though specific conditions, like obesity, could influence their drafting. The cast and fixation systems usually applied in pediatric fractures provide a growth plate sparing, a satisfying reduction, and good stress resistance, mostly because of a lower bodyweight compared to adults. Several studies suggest that obesity influences the bone quality, the management, and the outcomes in cases of fracture. High body weight increases the risk of trauma, modifies fracture characteristics, and increases the risk of incomplete reduction. Fractures in obese children have a higher rate of complications, regardless of conservative or surgical treatment. In obese children, surgical treatment is often used more frequently than with non-obese children. Such considerations are valid both for lower and upper limb fractures. The aim of this paper is to discuss recent scientific literature and provide a perspective on the benefits of a dedicated approach in the management of obese children. Guideline updates could improve healthcare quality in a pediatric setting, and also reduce medico-legal implications.

Original languageEnglish
Article number207
JournalFrontiers in Pediatrics
Volume8
DOIs
Publication statusPublished - May 8 2020

Keywords

  • childhood obesity
  • clinical practice guidelines
  • limb fractures
  • orthopedic
  • trauma surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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