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Mulvihill H, Roster K, Lakhi N. Obesity as a Risk Factor for Adverse Outcomes After Pedestrian Trauma Accidents in the Pediatric Population. Pediatr Emerg Care 2024; 40:498-503. [PMID: 38718818 DOI: 10.1097/pec.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVE The aim of the study is to determine whether overweight or obese children are at an increased risk for injury and adverse outcomes following pedestrian motor vehicle accidents. METHODS We performed a retrospective study of patients between the ages of 2 and 17 who were pedestrians injured in a collision with a motorized vehicle, presenting to a level 1 trauma center, between January 1, 2010, to December 31, 2021. Patients with admission weights falling above the 90th percentile of the Centers for Disease Control and Prevention's sex-specific growth charts were identified as overweight/obese, those below the cutoff were categorized as nonobese. Groups were compared regarding demographics, mechanism of injury, Injury Severity Score, and Abbreviated Injury Scale by body region of injury. Outcome measures included hospital admission, length of hospital stay, intensive care unit (ICU) admission, ICU length of stay, and mortality. RESULTS Of the 306 patients included, 72 (23.5%) were overweight/obese and 234 (76.5%) were nonobese. The mean Injury Severity Score scores were higher among overweight/obese patients (5.37 vs 8.74, P = 0.008). Overweight/obese children were more likely to sustain severe abdominal injuries (Abbreviated Injury Scale ≥ 3) (12.2% vs 5.1%; odds ratio [OR], 2.64; 95% CI, 1.07-6.56; P = 0.030), be admitted to the hospital (94.5% vs 74.3%; OR, 12.07; 95% CI, 2.87-50.72; P < 0.001), require ICU admission (31.0% vs 20.0%, OR, 1.87; 95% CI, 1.03-3.36; P = 0.036), and require a longer ICU stay (0.9 vs 0.4 days, P = 0.014) compared with nonobese patients. CONCLUSIONS Obese and overweight children are at increased risk for higher injury severity scores, severe abdominal injuries, and ICU admission after pedestrian motor vehicle accidents.
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Affiliation(s)
| | - Katie Roster
- From the New York Medical College School of Medicine, Valhalla, NY
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Kemal S, Ramgopal S, Macy ML. Traumatic Injuries and Radiographic Study Utilization Among Children With Drowning Presenting to U.S. Pediatric Hospitals. Acad Pediatr 2024; 24:677-685. [PMID: 37743013 DOI: 10.1016/j.acap.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE The role of traumatic injuries in fatal and nonfatal drownings is poorly described. We sought to characterize the incidence of traumatic injuries and diagnostic imaging performed among children who received pediatric hospital care for drowning. METHODS We conducted a retrospective study of children (≤18 years) with drowning encounters at 45 pediatric hospitals, October 2015 through December 2020. We described the presence of clinically important traumatic injuries to the following body regions: brain, spinal cord, thoracic and intra-abdominal organs, axial skeleton, pelvis, and long bones, and major vessels. We described patient characteristics and radiographic testing. We compared patients with and without traumatic injuries using the Fisher's exact and Wilcoxon signed rank tests. RESULTS We identified 10,397 children with a drowning encounter. Most (83.4%) were treated in the emergency department and 52.8% were admitted. There were 238 (2.3%) encounters with clinically important traumatic injuries. Intracranial injury was the most common (1.0%) with other traumatic injuries occurring in ≤0.5%. Less than 2% of children had a moderate or severe injury severity score and approximately half of these children had a clinically important traumatic injury. Among children with traumatic injuries, a higher proportion were 10 to 14 or 15 to 18 years old and from ZIP codes with lower median household income. Computerized tomography imaging was performed in the following proportions: brain (11.4%), cervical spine (3.7%), abdomen/pelvis (1.2%), chest (0.5%) and face/orbits (0.2%). CONCLUSIONS Clinically important traumatic injuries in children with drowning are rare. Further studies are needed to guide the optimal utilization of radiographic studies in this population.
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Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Sriram Ramgopal
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (S Ramgopal and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Michelle L Macy
- Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (S Ramgopal and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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Yoshiyama T. Navigating Challenges and Treatment Options in Diaphyseal Forearm Fractures Among Adolescents: Case Series and Narrative Review. Cureus 2023; 15:e40669. [PMID: 37485145 PMCID: PMC10356996 DOI: 10.7759/cureus.40669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
In this paper, we recount the medical trajectories of two male patients, both fourteen years of age, who sustained re-fractures of their radius and ulna six months post their primary diaphyseal fractures. Owing to the limited capacity for growth of the forearm bones between the ages of ten to sixteen years, many queries are engendered concerning apt treatment strategies. The pressing questions are whether these should be conservative or surgical and the precise method to be employed in surgical interventions. This discourse endeavors to demarcate preferred therapeutic options and shed light on a series of standard clinical dilemmas physicians encounter, along with an exhaustive scrutiny of existing literature.
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Xiao X, Ding Y, Zheng Y, Gao Y, Li H, Liu R, Xu R, Hong P. Epidemiological Investigation of Pediatric Fractures-A Retrospective Cohort Study of 1129 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040788. [PMID: 37109745 PMCID: PMC10144156 DOI: 10.3390/medicina59040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Fractures are common in pediatric trauma, and they are caused by a broad spectrum of factors. Only a few studies have discussed the mechanisms of injury and their relationships to different types of fractures. The most frequent type of fractures in different age groups remains unclear. Therefore, we aim to summarize the epidemiological characteristics of pediatric fractures in a medical center in Zhuhai, China from 2006 to 2021 and analyze the causes of fractures with the highest frequency in different age groups. Materials and Methods: We extracted the information from the Zhuhai Center for Maternal and Child Health Care of those under 14 years old who had fractures from 2006 to 2021. Results: We reviewed the information of 1145 children. The number of patients increased during the 15 years (p < 0.0001). The number of patients was significantly different between genders after Y2 (p = 0.014). In addition, more than two-thirds of patients (71.3%) had upper limb fractures, and all types of falls were the most common cause of fractures (83.6%). The incidence demonstrated an insignificant difference in age groups except for the fractures of humerus and radius. Moreover, we discovered that the prevalence of fall-related injuries decreased with age, while that of sports-related injuries increased with age. Conclusions: Our study demonstrates that the prevalence of fall-related injuries decreases with age, and that of sports-related injuries increases with age. Most patients have upper limb fractures, and all types of falls are the most common cause of fractures. Fracture types with the highest frequency differ in each age group. These findings might supplement current epidemiological knowledge of childhood fracture and provide references for decision-making in children's health policies.
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Affiliation(s)
- Xiaoliang Xiao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Yuhong Ding
- Second Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yiqiu Zheng
- Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yun Gao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Huaqing Li
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ruijing Xu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
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Obesity Increases Time to Union in Surgically Treated Pediatric Fracture Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202201000-00006. [PMID: 34986128 PMCID: PMC8735756 DOI: 10.5435/jaaosglobal-d-21-00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/10/2021] [Indexed: 12/28/2022]
Abstract
Introduction: To determine whether obesity affects time to radiographic union in surgically treated pediatric extremity fractures. Methods: A retrospective review of pediatric patients with extremity fractures at a Level 1 trauma center from 2010 to 2020. Those treated conservatively and patients with nonunions were excluded. Union was defined as radiographic evidence of bridging callus on all sides of the fracture and absence of the previous fracture line. Results: Obese patients had a markedly increased time to union when compared with others, even when age, sex, fracture type, race, and ethnicity were controlled for. The mean time to union for obese and nonobese patients were 152 and 93.59 days, respectively (P < 0.001). Obese patients had 3.39 times increased odds of having increased time to union. Obese patients had 6.64 times increased odds of having fractures with delayed union of 4 months or greater (P < 0.001). Conclusions: There is a positive correlation between obesity and time to union in surgically treated pediatric fracture patients.
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Alattar Z, Hoebee S, Ron E, Kang P, vanSonnenberg E. The Role of Obesity in Motor Vehicle Injuries and Fatalities in the Pediatric Population: A Systematic Review. J Intensive Care Med 2021; 37:472-479. [PMID: 33685267 DOI: 10.1177/0885066621992738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A systematic review done to evaluate obesity as a risk factor for injuries and mortality in motor vehicle accidents (MVAs) in the pediatric population, as there has not been a systematic review done in over 10 years. This study aims to update the literature regarding obesity as a risk factor for injuries in MVAs in the pediatric population. MATERIALS AND METHODS A systematic review was conducted according to the PRISMA guidelines with strict inclusion and exclusion criteria, resulting in the use of 3 total articles to analyze obesity as a risk factor for overall injury and mortality in the pediatric population. RESULTS Zaveri et al demonstrated a statistically significant, but weak, decrease in the odds of extremity injury in overweight patients ages 2 to 17 years old (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-1.0, P ≤ 0.05). On the other hand, Pollack et al and Haricharan et al found an increase in extremity injury in the obese population, in ages 9 to 15 years (OR = 2.54, 95% CI = 1.15-5.59, P ≤ 0.05), and 10 to 17 years (Age 10-13: OR = 6.06, 95% CI = 2.23-16.44, P ≤ 0.05, Age 14-17 OR = 1.44, 95% CI = 1.04-2.00, P ≤ 0.05), respectively. Haricharan et al also found an increase in thoracic injuries in obese children, ages 2 to 13 and increased risk of head/face/neck injury in obese children ages 2 to 5 (OR = 3.67, 95% CI = 1.03-13.08, P ≤ 0.05), but a decreased risk of head injury in obese children ages 14 to 17 (OR = 0.33, 95% CI = 0.18-0.60, P ≤ 0.05). CONCLUSIONS There are sparse data that are conflicting, regarding the effect of obesity on extremity injuries in the pediatric population. Obesity is not protective against thoracic, head, or abdominal injuries. However, it was found to be a risk factor for trunk injuries in ages 2 to 13, as well as head/face/neck injuries for ages 2 to 5. Since the literature is so sparse, further research is warranted in these areas.
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Affiliation(s)
- Zana Alattar
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Shelby Hoebee
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Eyal Ron
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Paul Kang
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Camp EA, Cruz AT, Shenoi RP. Obesity is associated with a reduced odds for blunt intra-abdominal injuries in children. Obes Res Clin Pract 2020; 14:54-59. [PMID: 32029392 DOI: 10.1016/j.orcp.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/31/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Children with obesity may possess unique injury characteristics that may affect their emergency care. To better understand this relationship, we investigated the association of obesity in pediatric trauma patients and intra-abdominal injuries (IAIs) and routinely utilized emergency department (ED) diagnostic procedures (computed tomography (CT) scans and ultrasound (US) examinations). METHODS This secondary data analysis utilized Pediatric Emergency Care Applied Research Network (PECARN) data from 2007 to 2010. Since height data were not available, children (2-17 years) with obesity were defined using weight-for-age percentiles. Non-parametric testing determined potential confounders. Adjusted odds ratios (aOR) were calculated using binary logistic regression for weight status and IAIs and diagnostic procedures. RESULTS There were 3846 patients with actual weight recorded: 3301 (85.8%) children without obesity and 545 (14.2%) with obesity. Children with obesity had decreased odds for IAI after adjusting for race, mechanical force injury (MFI) type, vomiting, and abdominal wall trauma (adjusted odds ratio (aOR)=0.58 (95% CI 0.35-0.97); p-value=0.04). Patients with obesity had reduced odds for a CT examination. No association was found between obesity status and US utilization. African-American patients had decreased odds for IAIs, CT scans and US examinations after adjustment which could be related to MFI type. CONCLUSIONS Obesity appears to reduce the odds for pediatric IAIs and CT scans, but not for US examinations. Selection bias is possible due to injury severity and missing or excluded weight data. Further research is needed in other pediatric populations with obesity and blunt injuries.
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Affiliation(s)
- Elizabeth A Camp
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Andrea T Cruz
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Rohit P Shenoi
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
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Donati F, Costici PF, De Salvatore S, Burrofato A, Micciulli E, Maiese A, Santoro P, La Russa R. A Perspective on Management of Limb Fractures in Obese Children: Is It Time for Dedicated Guidelines? Front Pediatr 2020; 8:207. [PMID: 32457859 PMCID: PMC7225297 DOI: 10.3389/fped.2020.00207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/07/2020] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Fabrizio Donati
- Department of General Surgery, Orthopedic Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Pier Francesco Costici
- Department of General Surgery, Orthopedic Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Aaron Burrofato
- Department of General Surgery, Orthopedic Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Enrico Micciulli
- Department of General Surgery, Orthopedic Institute, Bambino Gesù Children Hospital, Rome, Italy
| | - Aniello Maiese
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Santoro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Homaie Rad E, Khodadady-Hasankiadeh N, Kouchakinejad-Eramsadati L, Javadi F, Haghdoost Z, Hosseinpour M, Tavakoli M, Davoudi-Kiakalayeh A, Mohtasham-Amiri Z, Yousefzadeh-Chabok S. The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis. J Inj Violence Res 2019; 12:85-101. [PMID: 31863576 PMCID: PMC7001613 DOI: 10.5249/jivr.v12i1.1198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident. METHODS The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body. RESULTS A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found. CONCLUSIONS The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.
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Lee RJ, Margalit A, Nduaguba A, Gunderson MA, Wells L. Obesity and recovery of muscle strength after anterior cruciate ligament reconstruction in pediatric patients. J Orthop Surg (Hong Kong) 2019; 26:2309499018806631. [PMID: 30352544 DOI: 10.1177/2309499018806631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE: To explore factors influencing muscle strength after anterior cruciate ligament (ACL) reconstruction (ACLR) in pediatric patients. We hypothesized that obesity/overweight, autograft hamstring tendon, and concomitant injuries would be associated with slower muscle recovery. METHODS: We retrospectively reviewed the records of pediatric ACLR patients during a 3-year period. Muscle recovery was defined as ≥85% of peak torque compared with the contralateral side. We categorized patients as either obese/overweight or normal weight. Statistical analysis was performed using Mann-Whitney U, analysis of variance, and χ2 tests ( α level < 0.05). RESULTS: The study group consisted of 330 patients, of whom 198 (60%) and 231 (70%) met quadriceps and hamstring recovery criteria, respectively, at final testing (mean: 7.0 ± 3.2 months). Patients recovered hamstring and quadriceps strength at a mean of 5.3 ± 2.2 months and 6.1 ± 2.3 months, respectively. Hamstring muscle recovery took significantly longer in obese/overweight patients (mean: 5.7 ± 2.2 months) versus normal-weight patients (mean: 5.1 ± 2.1 months; p = 0.025), but quadriceps recovery did not (obese/overweight mean: 6.5 ± 2.6 months; normal-weight mean: 5.9 ± 2.1 months; p = 0.173). CONCLUSION: Concomitant injuries and graft type were not associated with length of time to recovery of muscle strength. Obesity/overweight was associated with delay in recovery of hamstring but not quadriceps strength.
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Affiliation(s)
- R Jay Lee
- 1 Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Margalit
- 1 Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Afam Nduaguba
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa A Gunderson
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lawrence Wells
- 2 Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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The Role of Obesity in Pediatric Orthopedics. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e036. [PMID: 31321371 PMCID: PMC6553626 DOI: 10.5435/jaaosglobal-d-19-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pediatric obesity has become a worldwide epidemic and leads to notable effects on the developing skeleton that can have lifelong implications. Obesity in the pediatric population alters bone metabolism, increasing the risk for fracture. It can alter the presentation of common pediatric orthopaedic conditions such as scoliosis. Obesity also leads to changes in the patterns and severity of pediatric fractures as well as alters conservative fracture treatment due to increased displacement risk. Obese pediatric trauma patients place a high burden on the nationwide hospital system in a variety of ways including the increased risk of perioperative complications. Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children.
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Abstract
Obese children with high-energy injuries present with more severe injuries, more extremity injuries, and higher Injury Severity Scores. They are at increased risk for complications, prolonged ventilation, and ICU stay and have increased mortality. Obesity is associated with altered bone mass accrual and higher fracture rates. Obese patients have a higher risk of loss of reduction of forearm fractures, more severe supracondylar fractures, and a higher likelihood of lateral condyle fractures. Obese patients are more likely to have complications with femur fractures and have higher rates of foot and ankle fracture.
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Location of Femoral Fractures in Patients with Different Weight Classes in Fall and Motorcycle Accidents: A Retrospective Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061082. [PMID: 29861486 PMCID: PMC6025576 DOI: 10.3390/ijerph15061082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to determine the incidence of femoral fracture location in trauma patients with different weight classes in fall and motorcycle accidents. Methods: A total of 2647 hospitalized adult patients with 2760 femoral fractures from 1 January 2009 to 31 December 2014 were included in this study. Femoral fracture sites were categorized based on their location: proximal femur (type A, trochanteric; type B, neck; and type C, head), femoral shaft, and distal femur. The patients were further classified as obese (body mass index [BMI] of ≥30 kg/m2), overweight (BMI of <30 but ≥25 kg/m2), normal weight (BMI of <25 but ≥18.5 kg/m2), and underweight (BMI of <18.5 kg/m2). Odds ratios and 95% confidence intervals of the incidences of femoral fracture location were calculated in patients with different weight classes in fall or motorcycle accidents, and they were then compared with those in patients with normal weight. p values of <0.05 were considered statistically significant. Results: Most of the fractures sustained in fall accidents presented in the proximal type A (41.8%) and type B (45.3%) femur, whereas those sustained in motorcycle accidents involved the femoral shaft (37.1%), followed by the distal femur (22.4%) and proximal type A femur (21.2%). In fall accidents, compared with normal-weight patients, obese and overweight patients sustained lower odds of risk for proximal type B fractures but higher odds of risk for femoral shaft and distal femoral fractures. In motorcycle accidents, compared with normal-weight patients, obese patients sustained lower odds of risk for proximal type B fractures but no difference in odds of risk for femoral shaft and distal femoral fractures. Overweight and underweight patients who sustained fractures in a motorcycle accident did not have different fracture location patterns compared with normal-weight patients. Conclusions: This study revealed that femoral fracture locations differ between fall and motorcycle accidents. Moreover, greater soft tissue padding may reduce impact forces to the greater trochanteric region in obese patients during fall accidents, and during motorcycle accidents, the energy transmitted and the point of impact may dominantly determine the location of femoral fractures.
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Abstract
BACKGROUND/PURPOSE The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. METHODS Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. RESULTS Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values <0.001). On multivariable analysis, higher BMI percentiles were associated with significantly increased likelihood of death, deep venous thrombosis, pulmonary embolus and pneumonia; although there was no difference in risk of overall complications. Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. CONCLUSIONS Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. LEVEL OF EVIDENCE Level III; prognosis study.
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Kim SJ, Ahn J, Kim HK, Kim JH. Obese children experience more extremity fractures than nonobese children and are significantly more likely to die from traumatic injuries. Acta Paediatr 2016; 105:1152-7. [PMID: 27634684 DOI: 10.1111/apa.13343] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/21/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
Abstract
UNLABELLED Two of the most prevalent problems children facing worldwide are injuries and obesity. We conducted a systematic review of published studies that evaluated the effects of obesity on children with traumatic injuries. Six studies published between 2006 and 2014 were identified, comprising a total of 4594 children: 867 were obese and 3727 were not. Obese children were 25% more likely to have extremity fractures than nonobese children (p = 0.003), and their mortality rate was significantly higher at 4.7% versus 2.8% (p = 0.026). CONCLUSION Our review showed that obese children were more likely to have extremity fractures and die of traumatic injuries than nonobese children.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Joonghyun Ahn
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Hyung Kook Kim
- Department of Orthopaedics; KEPCO Medical Foundation; KEPCO Medical Center; Seoul Korea
| | - Jong Hun Kim
- Division of Infectious Diseases; Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
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O'Neal EE, Plumert JM, McClure LA, Schwebel DC. The role of Body Mass Index in child pedestrian injury risk. ACCIDENT; ANALYSIS AND PREVENTION 2016; 90:29-35. [PMID: 26890078 PMCID: PMC4827859 DOI: 10.1016/j.aap.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/24/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
The goal of the current investigation was to examine obesity as a potential risk factor for childhood pedestrian injury. A racially diverse sample of 7- and 8-year-old children completed a road-crossing task in a semi-immersive virtual environment and two pedestrian route selection tasks. Multiple linear regression analyses revealed that children with a higher Body Mass Index (BMI) waited less before crossing, had a smaller temporal buffer between themselves and oncoming traffic while crossing, and had more collisions with traffic. Girls were more cautious than boys when crossing the virtual roadway. Unlike the results from the virtual road-crossing task, BMI was not associated with risky route selection. Instead, race emerged as the strongest predictor, with African-American children selecting riskier routes for crossing. Together, these findings suggest overweight and obese children may be at increased risk for pedestrian injury. The discussion considers explanations for why obese children may exhibit riskier road-crossing behavior.
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Affiliation(s)
- Elizabeth E O'Neal
- The University of Iowa, 11 Seashore Hall East, Iowa City, IA 52242, USA.
| | - Jodie M Plumert
- The University of Iowa, 11 Seashore Hall East, Iowa City, IA 52242, USA
| | - Leslie A McClure
- University of Alabama at Birmingham, Heritage Hall 571, 1720 2nd Ave S, Birmingham, AL 35233, USA
| | - David C Schwebel
- University of Alabama at Birmingham, Heritage Hall 571, 1720 2nd Ave S, Birmingham, AL 35233, USA
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17
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Pollock NK. Childhood obesity, bone development, and cardiometabolic risk factors. Mol Cell Endocrinol 2015; 410:52-63. [PMID: 25817542 PMCID: PMC4444415 DOI: 10.1016/j.mce.2015.03.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 03/21/2015] [Accepted: 03/21/2015] [Indexed: 12/29/2022]
Abstract
Osteoporosis and obesity are both major public health concerns. It has long been considered that these are distinct disorders rarely found in the same individual; however, emerging evidence supports an important interaction between adipose tissue and the skeleton. Whereas overweight per se may augment bone strength, animal studies suggest that the metabolic impairment that accompanies obesity is detrimental to bone. Obesity during childhood, a critical time for bone development, likely has profound and lasting effects on bone strength and fracture risk. This notion has received little attention in children and results are mixed, with studies reporting that bone strength development is enhanced or impaired by obesity. Whether obesity is a risk factor for osteoporosis or childhood bone health, in general, remains an important clinical question. Here, we will focus on clarifying the controversial relationships between childhood obesity and bone strength development, and provide insights into potential mechanisms that may regulate the effect of excess adiposity on bone.
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Affiliation(s)
- Norman K Pollock
- Department of Pediatrics, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA.
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18
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Abstract
The management of children's fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.
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Affiliation(s)
- D Kosuge
- The Princess Alexandra Hospital NHS Trust, Harlow, Essex CM20 1QX, UK
| | - M Barry
- The Royal London Hospital, London E1 1BB, UK
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19
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Kim JE, Hsieh MH, Shum PC, Tubbs RS, Allison DB. Risk and injury severity of obese child passengers in motor vehicle crashes. Obesity (Silver Spring) 2015; 23:644-52. [PMID: 25645729 PMCID: PMC4340813 DOI: 10.1002/oby.21018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the risk and injury severity on the regional body (head, neck, and chest) of obese children in frontal motor vehicle crashes (MVCs). METHODS No physical surrogates (i.e., crash dummies) for obese children were available, and experiments on pediatric cadavers were generally not feasible. Therefore, computational models of obese children using medical imaging processing and state-of-the-art modeling techniques were developed. A hybrid modeling technique was used to integrate the finite element model for torso fat layer into the standard multibody model to represent various levels of obese children for 3- and 6-year-old age groups. The models were used to investigate injury severity under various crash scenarios through model simulations. RESULTS The head injury criterion and chest acceleration were observed to increase as body mass index (BMI) increased. Meanwhile, no such correlations were found between BMI and neck injury and chest deformation. Forward head and torso excursions were observed to increase as obesity increased, owing to the momentum effect of greater body mass. CONCLUSIONS Obese children appeared to have greater risks for head and chest injuries than do their non-obese counterparts in frontal MVCs, owing to higher head and chest accelerations induced by greater body excursion.
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Affiliation(s)
- Jong-Eun Kim
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Min-Heng Hsieh
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Phillip C. Shum
- Department of Mechanical Engineering, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - R. Shane Tubbs
- Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL 35294, USA
| | - David B. Allison
- Nutrition Obesity Research Center, University of Alabama at Birmingham, AL 35294, USA
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20
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Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 2014; 14:314. [PMID: 25528249 PMCID: PMC4302599 DOI: 10.1186/s12887-014-0314-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 12/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children and adolescents are at high risk of sustaining fractures during growth. Therefore, epidemiological assessment is crucial for fracture prevention. The AO Comprehensive Injury Automatic Classifier (AO COIAC) was used to evaluate epidemiological data of pediatric long bone fractures in a large cohort. METHODS Data from children and adolescents with long bone fractures sustained between 2009 and 2011, treated at either of two tertiary pediatric surgery hospitals in Switzerland, were retrospectively collected. Fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). RESULTS For a total of 2716 patients (60% boys), 2807 accidents with 2840 long bone fractures (59% radius/ulna; 21% humerus; 15% tibia/fibula; 5% femur) were documented. Children's mean age (SD) was 8.2 (4.0) years (6% infants; 26% preschool children; 40% school children; 28% adolescents). Adolescent boys sustained more fractures than girls (p < 0.001). The leading cause of fractures was falls (27%), followed by accidents occurring during leisure activities (25%), at home (14%), on playgrounds (11%), and traffic (11%) and school accidents (8%). There was boy predominance for all accident types except for playground and at home accidents. The distribution of accident types differed according to age classes (p < 0.001). Twenty-six percent of patients were classed as overweight or obese - higher than data published by the WHO for the corresponding ages - with a higher proportion of overweight and obese boys than in the Swiss population (p < 0.0001). CONCLUSION Overall, differences in the fracture distribution were sex and age related. Overweight and obese patients seemed to be at increased risk of sustaining fractures. Our data give valuable input into future development of prevention strategies. The AO PCCF proved to be useful in epidemiological reporting and analysis of pediatric long bone fractures.
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21
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Sabhaney V, Boutis K, Yang G, Barra L, Tripathi R, Tran TT, Doan Q. Bone fractures in children: is there an association with obesity? J Pediatr 2014; 165:313-318.e1. [PMID: 24836073 DOI: 10.1016/j.jpeds.2014.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/24/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relationship between body mass index (BMI) and odds of extremity bone fractures in children. STUDY DESIGN This was a prospective cross-sectional study conducted at 2 tertiary care pediatric emergency departments. A convenience sample of children 2-17 years of age with a nonpenetrating extremity injury was enrolled. Demographics, activity level, mechanism of injury, participant BMI, and presence of a fracture were recorded. The main outcome was the odds of an extremity bone fracture based on BMI category; logistic regression was used to estimate the odds of fracture by BMI category. RESULTS We enrolled 2213 children, of whom 1078 (48.7%) sustained a fracture and 316 (14.3%) were classified as obese. The mean (SD) age was 9.5 (4.2) years, and percentage of male children was 56.8%. Compared with children with a normal BMI, the adjusted odds of fracture among obese, overweight, and underweight children were 0.75 (0.58, 0.97), 1.15 (0.89, 1.48), and 1.44 (1.00, 2.07) respectively. CONCLUSIONS Obese children had a minor but statistically significant decreased odds of fracture relative to children with a normal BMI, but no association was observed in overweight children. However, underweight children were found to be at an increased odds of fracture. This study suggests that overweight and obese children do not have increased odds of extremity fracture.
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Affiliation(s)
- Vikram Sabhaney
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Gaby Yang
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lorena Barra
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reetika Tripathi
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tinh Trung Tran
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quynh Doan
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
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22
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Kwan C, Doan Q, Oliveria JP, Ouyang M, Howard A, Boutis K. Do obese children experience more severe fractures than nonobese children? A cross-sectional study from a paediatric emergency department. Paediatr Child Health 2014; 19:251-5. [PMID: 24855428 DOI: 10.1093/pch/19.5.251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine whether there is an association between childhood obesity and severe extremity fractures. Associations between obesity and complications related to the fracture and/or fracture management were also examined. METHODS The present study was a retrospective, cross-sectional study conducted at a tertiary care children's emergency department. Eligible cases for review were children (two to 17 years of age) with an extremity fracture. Severe extremity fractures were defined as those requiring manipulation under anesthesia, open operative repair and/or admission to hospital. The primary outcome was the proportion of severe extremity fractures and the secondary outcome was the proportion of complications. RESULTS A total of 1340 charts of children who presented with extremity fracture from January 2008 to December 2010 were reviewed. The mean (± SD) age of the study population was 9.1±4.0 years and 62.1% were male. Overall, 19.9% (95% CI 17.8% to 22.0%) were obese and 39.6% (95% CI 36.7% to 39.1%) sustained a severe extremity fracture. The OR of severe extremity fractures among obese versus nonobese children was 1.00 (95% CI 0.76 to 1.32), adjusted for age, sex and mechanism of injury. In addition, the OR of experiencing complications among obese relative to nonobese children was 1.12 (95% CI 0.68 to 1.85). CONCLUSIONS The results of the present study demonstrated that in children with extremity fractures, obese children were not at increased risk for sustaining more severe extremity fractures or subsequent complications compared with nonobese children.
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Affiliation(s)
- Charisse Kwan
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Quynh Doan
- Division of Emergency Medicine, Department of Paediatrics, British Columbia Children's Hospital and University of British Columbia
| | - John Paul Oliveria
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Melissa Ouyang
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Andrew Howard
- Department of Orthopaedic Surgery, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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23
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Silver D, Macinko J, Bae JY, Jimenez G, Paul M. Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980-2010. Public Health 2013; 127:1117-25. [PMID: 24275035 DOI: 10.1016/j.puhe.2013.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/03/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the impact of variation in state laws governing traffic safety on motor vehicle fatalities. STUDY DESIGN Repeated cross sectional time series design. METHODS Fixed effects regression models estimate the relationship between state motor vehicle fatality rates and the strength of the state law environment for 50 states, 1980-2010. The strength of the state policy environment is measured by calculating the proportion of a set of 27 evidence-based laws in place each year. The effect of alcohol consumption on motor vehicle fatalities is estimated using a subset of alcohol laws as instrumental variables. RESULTS Once other risk factors are controlled in statistical models, states with stronger regulation of safer driving and driver/passenger protections had significantly lower motor vehicle fatality rates for all ages. Alcohol consumption was strongly associated with higher MVC death rates, as were state unemployment rates. CONCLUSIONS Encouraging laggard states to adopt the full range of available laws could significantly reduce preventable traffic-related deaths in the U.S. - especially those among younger individuals. Estimating the relationship between different policy environments and health outcomes can quantify the result of policy gaps.
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Affiliation(s)
- D Silver
- Department of Nutrition, Food Studies and Public Health, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA.
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24
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Bae JY, Anderson E, Silver D, Macinko J. Child passenger safety laws in the United States, 1978-2010: policy diffusion in the absence of strong federal intervention. Soc Sci Med 2013; 100:30-7. [PMID: 24444836 DOI: 10.1016/j.socscimed.2013.10.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/20/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.
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Affiliation(s)
- Jin Yung Bae
- Steinhardt School of Culture, Education and Human Development, New York University, USA.
| | | | - Diana Silver
- Steinhardt School of Culture, Education and Human Development, New York University, USA
| | - James Macinko
- Steinhardt School of Culture, Education and Human Development, New York University, USA
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Smith SM, Sumar B, Dixon KA. Musculoskeletal pain in overweight and obese children. Int J Obes (Lond) 2013; 38:11-5. [PMID: 24077005 PMCID: PMC3884137 DOI: 10.1038/ijo.2013.187] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/11/2013] [Accepted: 09/21/2013] [Indexed: 01/06/2023]
Abstract
This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain.
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Affiliation(s)
- S M Smith
- 1] Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia [2] Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, UK
| | - B Sumar
- Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia
| | - K A Dixon
- Family and Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Campbelltown, NSW, Australia
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26
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Kim JE, Hsieh MH, Soni BK, Zayzafoon M, Allison DB. Childhood obesity as a risk factor for bone fracture: a mechanistic study. Obesity (Silver Spring) 2013; 21:1459-66. [PMID: 23512354 PMCID: PMC3740028 DOI: 10.1002/oby.20355] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 12/03/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the risk of bone fracture sustained by obese children exposed to falls. The bone fracture risk of obese children would be greater than that of their nonobese counterparts was hypothesized. DESIGN AND METHODS Finite element-based computational models for children that reflected various levels of obesity by varying body mass and the thickness of the subcutaneous adipose tissue layer was developed. The models took account of both the momentum effect of variation of body mass and the cushion effect of variation of soft tissue thickness and examined these two contradictory effects on pelvic bone fracture risk through a set of sideways fall simulations with a range of impact speeds. RESULTS The critical impact speed that yielded pelvic bone fracture decreased as the levels of obesity increased, which meant that the momentum effect of a greater body mass took precedence over the cushion effect of the soft tissue layer. CONCLUSIONS The result suggests that obese children have a greater risk of pelvic bone fracture than do their nonobese counterparts in sideways falls. A further implication is that current child safety devices, systems, and regulations will need to be revisited as the prevalence of child obesity increases.
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Affiliation(s)
- Jong-Eun Kim
- Department of Mechanical Engineering, University of Alabama at Birmingham, AL, USA.
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27
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Adams AL, Kessler JI, Deramerian K, Smith N, Black MH, Porter AH, Jacobsen SJ, Koebnick C. Associations between childhood obesity and upper and lower extremity injuries. Inj Prev 2013; 19:191-7. [PMID: 22789612 PMCID: PMC3747966 DOI: 10.1136/injuryprev-2012-040341] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate the overall and age-specific associations between obesity and extremity musculoskeletal injuries and pain in children. METHODS This cross-sectional study used information from electronic medical records of 913178 patients aged 2-19 years enrolled in an integrated health plan in the period 2007-2009. Children were classified as underweight, normal weight, overweight, or moderately/extremely obese and, using multivariable logistic regression methods, the associations between weight class and diagnosis of upper or lower extremity fractures, sprains, dislocations and pain were calculated. RESULTS Overweight (OR 1.18, 95% CI 1.15 to 1.20), moderately obese (OR 1.24, 95% CI 1.20 to 1.27) and extremely obese (OR 1.34, 95% CI 1.30 to 1.39) children had statistically significantly higher odds of lower extremity injuries/pain compared to normal weight, adjusted for sex, age, race/ethnicity and insurance status. Age-stratified analyses yielded similar results. No consistent association was observed between body mass index and injuries/pain of the upper extremities. CONCLUSIONS Greater body mass index is associated with increased odds of lower extremity injuries and pain issues. Because the benefits of physical activity may still outweigh the risk of injury, attention should be paid to injury prevention strategies for these children at greater risk for lower extremity injuries.
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Affiliation(s)
- Annette L Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
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28
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Vulnerable roadway users struck by motor vehicles at the center of the safest, large US city. J Trauma Acute Care Surg 2013; 74:1138-45. [PMID: 23511157 DOI: 10.1097/ta.0b013e31827ab722] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Road safety constitutes an international crisis. In 2010, 11,000 pedestrians and 3,500 bicyclists were injured by motor vehicles in New York City. This study aims to identify the demographics, behaviors, injuries, and outcomes of vulnerable roadway users struck by motor vehicles in New York City's congested central business district and surrounding periphery. METHODS A prospective, descriptive study of pedestrians and bicyclists struck by motor vehicles and treated at a Level I regional trauma center was performed. Data were collected between December 2008 and June 2011 by interviewing patients and first responders supplemented with imaging and outcomes variables. Main outcome measures included patient demographics, behavior patterns, scene-related data, Injury Severity Score (ISS), and outcomes including mortality. Multivariate ordinal logistic regression modeling was performed to isolate effects of predictor variables on outcome of ISS categories. RESULTS Injured pedestrians (n = 1,075) and bicyclists (n = 382) differ by age (p < 0.001), sex (p < 0.001), ethnicity/race (p < 0.001), and involved motor vehicle type (p < 0.001). Pedestrians sustain more severe/critical injuries (p < 0.001) and hospital admissions (p < 0.001). Bicyclists are more commonly struck by taxis (p < 0.001) and infrequently wear helmets (29.6%). Variables associated with low ISS include bicycling (adjusted odds ratio [AOR], 0.43; 95% confidence interval [CI], 0.29-0.63), above normal body mass index (AOR, 0.73; 95% CI, 0.54-0.99), Latino (AOR, 0.65; 95% CI, 0.46-0.94) or black (AOR, 0.63; 95% CI, 0.41-0.96) ethnicity/race, and struck by a taxicab (AOR, 0.50; 95% CI, 0.33-0.76) or turning vehicle (AOR,0.49; 95% CI, 0.34-0.70). Variables associated with high ISS include alcohol (AOR, 2.71; 95% CI, 1.81-4.05), age less than 18 years (AOR, 1.73; 95% CI, 1.05-2.86), hearing impairment (AOR, 2.24; 95% CI, 1.24-4.03), and struck by a truck or bus (AOR, 1.91; 95% CI, 1.18-3.10). Mortality was 1.2%. CONCLUSION Injured pedestrians and bicyclists represent distinct entities. Prevention modalities must be tailored accordingly with a focus on high-risk subgroups and compliance with traffic laws. Studying fatality or admissions data fail to capture the extent of the epidemic. LEVEL OF EVIDENCE Prospective epidemiologic study, level II.
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29
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Zhou L, Chen D, Dong G. Characteristics and related factors of nonfatal injuries among adolescents and college students in Shenzhen City of China. BMC Public Health 2013; 13:392. [PMID: 23617938 PMCID: PMC3649915 DOI: 10.1186/1471-2458-13-392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/22/2013] [Indexed: 11/23/2022] Open
Abstract
Background Injuries impact adolescents and young adults in unique ways. The purpose of this study was to determine the incidence rate of nonfatal injuries, and identify characteristics and risk factors for the injuries among adolescents and college students in Shenzhen, China. Methods A total of 4,138 students from 79 classes were selected using a purposive sampling method in 2010. The questionnaire included personal demographics, behavioral factors, and self-perceived agrypnia. Stepwise multivariate logistic regression models were used to explore the risk factors of injury. Results The annual incidence rate of nonfatal injuries was 13.5%. Injuries were significantly correlated with gender (boys vs. girls, adjusted odds ratio [OR], 1.58, 95% confidence interval [CI], 1.30-1.93) and self-perceived agrypnia (sometimes vs. no, adjusted OR, 1.64, 95% CI, 1.31-2.05; often vs. no, adjusted OR, 2.34, 95% CI, 1.74-3.14), attending PE class ( >2 classes/week vs. ≤ 2 classes/week, adjusted OR, 1.25, 95% CI, 1.04-1.51), sexual behaviors (yes vs. no, adjusted OR, 1.46, 95% CI, 1.03-2.07), physical fighting (yes vs. no, adjusted OR, 1.84, 95% CI, 1.49-2.28), alcohol consumption (yes vs. no, adjusted OR, 1.29, 95% CI, 1.06-1.59), unsafe cycling (yes vs. no, adjusted OR, 1.47, 95% CI, 1.20-1.80) and skating in unsafe places (yes vs. no, adjusted OR, 1.57, 95% CI, 1.10-2.24). Additionally, falls were the leading cause of injuries, and gymnasiums of schools were the most-reported places where injuries occurred. Conclusions Nonfatal injuries have turned into a pressing public health problem among adolescents and college students in Shenzhen, China. Strategies targeting the risk factors may be effective for the prevention of injuries.
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Affiliation(s)
- Li Zhou
- Shenzhen Center for Disease Control and Prevention, No, 8 Longyuan Road, Nanshan District, Shenzhen, Guangdong Province 518055, China.
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Kessler J, Koebnick C, Smith N, Adams A. Childhood obesity is associated with increased risk of most lower extremity fractures. Clin Orthop Relat Res 2013; 471:1199-207. [PMID: 23054515 PMCID: PMC3586019 DOI: 10.1007/s11999-012-2621-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A number of studies have found an increased risk of lower extremity injuries in obese patients. Most studies, however, are unable to provide stable population-based estimates based on the degree of obesity and few assess the risk pertaining to more detailed fracture location in the lower extremities. QUESTIONS/PURPOSES We therefore investigated the relationship between obesity and lower extremity fractures in different age and fracture locations in a stable population. METHODS This is a population-based, cross-sectional study from the electronic medical records of 913,178 patients aged 2 to 19 years. The body mass index (BMI) for each patient in the cohort was used to stratify patients into five weight classes (underweight, normal weight, overweight, moderate obesity, and extreme obesity) based on BMI for age. Records were assessed for the occurrence of lower extremity fractures for each cohort member. The associations among the five weight classes and specific lower extremity fractures were estimated using multiple logistic regression models and expressed with odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate analysis to adjust for patient demographic variables. RESULTS Overweight, moderately obese, and extremely obese patients all had an increased OR of fractures of the foot (OR, 1.14, 1.23, and 1.42, respectively, with 95% CI, 1.04-1.24, 1.12-1.35, and 1.26-1.61, respectively) along with the ankle, knee, and leg (OR, 1.27, 1.28, and 1.51, respectively, with 95% CI, 1.16-1.39, 1.15-1.42, and 1.33-1.72, respectively). The association was strongest in the 6- to 11-year-old age group. We found no association between increasing BMI and increased risk of fractures of the femur and hip. CONCLUSIONS Increasing BMI is associated with increased odds of foot, ankle, leg, and knee fractures in children. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeff Kessler
- Kaiser Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027 USA ,Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Corinna Koebnick
- Kaiser Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027 USA ,Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Ning Smith
- Kaiser Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027 USA ,Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Annette Adams
- Kaiser Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027 USA ,Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
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Abstract
BACKGROUND Obesity is a risk factor for various orthopaedic diseases, including fractures. Obesity's influence on circulating hormones and cytokines and bone mineralization ultimately influences the body's osteogenic response and bone mineralization, potentially increasing the risk of fracture and impacting fracture healing. QUESTIONS/PURPOSES Does obesity delay fracture recovery in overweight or obese children as measured by the time to release to normal activity? Is this average time for return to activity influenced by the mechanism of the injury? Does obesity's effect on mineralization and loading in overweight or obese children lead to a greater proportion of upper extremity fracture versus lower extremity fracture? METHODS We prospectively followed 273 patients with nonpathologic long bone fractures treated from January 2010 to October 2011. Patients were stratified into obese/overweight, normal weight, and underweight groups. All patients were followed until release to regular activities (mean, 41 days; range, 13-100 days). RESULTS Release to regular activities occurred sooner in obese/overweight than in normal weight patients: 39 and 42 days, respectively. A greater proportion of obese/overweight patients had low to moderate energy mechanisms of injury than did normal weight patients, but we found no difference between the groups in terms of return to activity when stratified by mechanism. There was also no difference in the proportion of upper extremity injuries between the two groups. CONCLUSIONS Obese/overweight children did not have a delay in release to activities compared with children of normal weight. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Rushyuan J. Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Nigel N. Hsu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Colleen M. Lenz
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Arabella I. Leet
- Shriners Hospital for Children®-Honolulu, 1310 Punahou Street, Honolulu, HI 96826-1099 USA
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Abstract
The prevalence of obesity among children and adults is increasing worldwide. There are substantial health risks and financial costs associated with the obesity epidemic that impact the practice of orthopaedic surgery. Patients with increased body mass index are more prone to sustaining distal extremity injuries than are those with a normal body mass index. Obese individuals are more likely than nonobese individuals to seek treatment for osteoarthritis of the knee.
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Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Doctor’s Office Center, 90 Bergen Street, Suite 7300, Newark, NJ 07103, USA.
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Abstract
Obese children have a theoretically increased risk of sustaining an extremity fracture because of potential variations in their bone mineral density, serum leptin levels, and altered balance and gait. Trauma databases suggest an increased rate of extremity fractures in obese children and adolescents involved in polytrauma compared with nonobese children and adolescents. Anesthetic and other perioperative concerns for obese pediatric trauma patients undergoing surgery include higher baseline blood pressures, increased rates of asthma, and obstructive sleep apnea. A child's weight must be considered when choosing the type of implant for fixation of pediatric femoral fractures. Fracture prevention strategies in obese pediatric patients consist of ensuring properly sized safety gear for both motor vehicles and sporting activities and implementing structured weight-loss programs.
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Affiliation(s)
- Meredith A Lazar-Antman
- Pediatrics Division, Department of Orthopaedic Surgery, Winthrop-University Hospital 222 Station Plaza North, Suite 305, Mineola, NY 11501, USA.
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Zonfrillo MR, Elliott MR, Flannagan CA, Durbin DR. Association between weight and risk of crash-related injuries for children in child restraints. Pediatrics 2011; 128:1148-52. [PMID: 22123879 DOI: 10.1542/peds.2010-3810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the association between weight and the risk of injury in motor vehicle crashes (MVCs) for children 1 through 8 years of age who were using child restraints. METHODS This was a cross-sectional study of children 1 to 8 years of age in MVCs, in which cases from the National Automotive Sampling System Crashworthiness Data System were used. Abbreviated Injury Scale scores of ≥2 indicated clinically significant injuries. RESULTS The National Automotive Sampling System Crashworthiness Data System study sample included 650 children 1 to 5 years of age in forward-facing child restraints who weighed 20 to 65 lb and 344 children 3 to 8 years of age in belt-positioning booster seats who weighed 30 to 100 lb. With adjustment for seating position, type of vehicle, direction of impact, crash severity, and vehicle model year, there was no association between absolute weight and clinically significant injuries in either age group (odds ratio: 1.17 [95% confidence interval: 0.96-1.42] for children 1-5 years of age in forward-facing child restraints and 1.22 [95% confidence interval: 0.96-1.55] for children 3-8 years of age in belt-positioning booster seats). CONCLUSIONS The risk of clinically significant injuries was not associated with weight across a broad weight range in this sample of children in MVCs who were using child restraint systems. Parents should continue to restrain their children according to current recommendations from the American Academy of Pediatrics and the National Highway Traffic Safety Administration.
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Affiliation(s)
- Mark R Zonfrillo
- Department ofPediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Abstract
Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.
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Pollock NK, Laing EM, Hamrick MW, Baile CA, Hall DB, Lewis RD. Bone and fat relationships in postadolescent black females: a pQCT study. Osteoporos Int 2011; 22:655-65. [PMID: 20449571 DOI: 10.1007/s00198-010-1266-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 03/30/2010] [Indexed: 11/29/2022]
Abstract
UNLABELLED Despite adolescent black females experiencing the highest rates of obesity, the effect of excess fat mass on bone structure and strength in this population is unknown. Our findings in postadolescent black females suggest that excess weight in the form of fat mass may adversely influence cortical bone structure and strength. INTRODUCTION Although adolescent obesity has been associated with reduced bone structure and strength in white females, this relationship has not been studied in adolescent black females, a population experiencing the highest rates of obesity. Our objective was to compare bone structure and strength between postadolescent black females with normal and high levels of adiposity. METHODS Black females with ≤ 32% body fat were classified as normal body fat (NF; n = 33, aged 19.3 ± 1.3 years); females exceeding this cutoff were classified as high body fat (HF; n = 15, aged 19.0 ± 1.1 years). Using peripheral quantitative computed tomography, tibial and radial bones were scanned at the 4% (trabecular) and 20% (cortical) sites from the distal metaphyses. Fat-free soft-tissue mass (FFST) and %body fat were assessed by dual-energy X-ray absorptiometry. RESULTS After controlling for either FFST or body weight, the HF vs. NF group had lower total cross-sectional area (CSA; 9-17%), cortical CSA (6-15%), and strength-strain index (SSI; 13-24%) at the cortical site of the tibia (all p < 0.05). At the cortical site of the radius, the HF vs. NF group had lower total CSA (14%, p = 0.03), cortical CSA (9%, p = 0.04), and SSI (15%, p = 0.07) after control for body weight. There were no group differences in either the FFST-adjusted cortical bone values at the radius or in the trabecular bone parameters (body weight- or FFST-adjusted) at the tibia and radius. CONCLUSIONS Consistent with our adiposity and bone data in late-adolescent white females, our findings in black females entering adulthood also suggest that obesity may adversely influence cortical bone strength.
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Affiliation(s)
- N K Pollock
- Department of Pediatrics, Medical College of Georgia, Augusta, GA, USA.
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Sayegh R, Bradley D, Vaca FE. Pediatric obesity in motor vehicle collisions. J Emerg Nurs 2010; 36:501-3. [PMID: 20837228 DOI: 10.1016/j.jen.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rockan Sayegh
- Center for Trauma and Injury Prevention Research, University of California, Irvine Medical Center, Orange, CA, USA
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