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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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The Impact of Obesity on Neurovascular Injuries in Supracondylar Fracture Patients
Andrew Yang, MD; George A. Beyer, MS; Max Solow, BS; Sarah G. Stroud, AB; Erika Kuehn, MD; Bassel G. Diebo, MD; Steven M. Koehler, MD; Emmanuel Illical, MD; Khalid Hesham, MD
State University of New York, Downstate Medical Center, Brooklyn, NY

Introduction:
Obesity is reaching epidemic levels in the United States within both general and pediatric populations. Obese individuals are increased risk of adverse psychological and health consequences, including increased fracture risk. Supracondylar humerus fractures are among the most common fractures within pediatric patients and pose a significant risk of neurovascular complications. This study aimed to determine whether obesity was a significant predictor of neurovascular complications following supracondylar humerus fracture.

Materials/Methods:
This was a retrospective review using the National Inpatient Sample (NIS) from 2005-2012. Patients with open and closed supracondylar humerus fractures were identified by ICD-9 codes and stratified using the NIS obesity assignment (present vs. not). ICD-9 codes were utilized to identify axillary, median, ulnar, radial, musculocutaneous, cutaneous sensory, and digital nerve injuries. Vascular injuries such as brachial laceration, radial vessel damage, upper extremity thrombosis, compartment syndrome, and osteonecrosis were also identified. Univariate analysis compared rates of neurological and vascular complications between obese and non-obese patients. Multivariate binary stepwise logistic regression models identified independent predictors of neurovascular complications (covariates: age, gender, Deyo Index score, and fracture pattern [open vs. closed]).

Results: 23,319 patients were identified with supracondylar humeral fractures (Obese: n=629, mean age: 54.9 years; Non-Obese: n=22,500, mean age: 26.48 years). From 2005-2012, the proportion of obese patients with supracondylar fractures significantly increased from 1.79% to 3.5% (p<0.001). A larger proportion of obese patients had open fracture patterns when compared to non-obese (14.9% vs. 8.1%, p<0.001). Obese patients experienced significantly greater rates of neurological injury: ulnar nerve injury (2.1% vs. 1.0%), ulnar nerve lesion (2.70% vs. 0.70%), radial nerve lesion (2.20% vs. 0.71%), and total neurological complications (7.8 vs. 3.6%) (all p<0.011). Obesity was a significant independent predictor of neurological damage in patients with supracondylar fractures (OR: 1.804 [95% CI: 1.265-2.574]. Fracture type (open vs. closed) was the strongest predictor of neurological complications (OR: 2.895 [2.378-3.524]) (all p<0.001). Rates of vascular injuries did not differ significantly between groups.

Conclusion: To date, few studies have reported on the association between obesity and the incidence of neurovascular injury following supracondylar humerus fracture. This investigation identified a significant increase in incidence of neurological complications among obese patients and highlights obesity as a strong independent predictor of neurological complications in the setting of supracondylar fracture. These findings have important implications for the management of supracondylar fractures within the obese population and underscore the importance of current efforts to curb obesity.


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