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Is High Weight Status Associated With Pediatric Forearm Fractures Requiring Anatomic Reduction?
  1. Leticia Manning Ryan, MD, MPH*,
  2. Stephen J. Teach, MD, MPH,
  3. Uchenna Ezeibe, BS,
  4. Ambika Lall, BS§,
  5. Rachel Wood, BS,
  6. James M. Chamberlain, MD
  1. From the *Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, MD; †Children’s National Medical Center, George Washington University School of Medicine and Health Science, Washington, DC; ‡C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI; §St. Christopher’s Hospital for Children, Philadelphia, PA; and ∥Tufts University School of Medicine, Boston, MA.
  1. Received June 20, 2014, and in revised form January 13, 2015.
  2. Accepted for publication January 21, 2015.
  3. Reprints: Leticia Manning Ryan, MD, MPH, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, 1800 Orleans St, Suite G-1509, Baltimore, MD 21287. E-mail: lryan17{at}jhmi.edu.
  4. This study is funded in part by the National Institutes of Health National Center for Research Resources (1 K23 RR024467-01) and the Children’s National Medical Center Children’s Research Institute Research Advisory Council.
  5. The authors declare no conflicts of interest.
  6. Presentation at meetings: This work was formally presented at the American Federal for Medical Research Eastern Regional Meeting in Washington, DC in April 2011 and the National Medical Association 2011 Annual Convention and Scientific Assembly in Washington DC in August 2011.

Abstract

Background High weight status is associated with increased forearm fracture risk but its relationship to severity of fracture has not been evaluated. We compared the epidemiology of children’s forearm fractures treated with fracture reduction to those not treated with reduction, hypothesizing that high weight status would be significantly associated with need for reduction.

Methods This is a case-control study including Washington, DC children, ages 2 to 17 years, treated for isolated forearm fractures in an urban, tertiary care pediatric emergency department from 2003 to 2006. Descriptive statistics and logistic regression were conducted to compare patients with forearm fracture reductions to nonintervention controls.

Results Of 888 forearm fractures, 330 (37.2%) required reduction (cases) whereas 558 (64.8%) did not (controls). Cases were more likely than controls to be male [adjusted odds ratio, 1.67 (95% confidence interval, 1.11–2.50)] and to have experienced a more severe mechanism of trauma [adjusted odds ratio, 2.11 (95% confidence interval, 1.14–3.90)]. The groups did not differ in weight status, age, or race/ethnicity.

Conclusions The need for reduction among children with forearm fractures is significantly associated with male sex and major mechanisms of trauma but not with high weight status. Strategies to reduce severe forearm fractures should focus on preventing major mechanisms of trauma.

Key Words
  • forearm fracture
  • child injury
  • forearm reduction
  • forearm displacement
  • obesity

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