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Obese kids may face higher risk of bad elbow breaks

By Kathleen Raven

NEW YORK (Reuters Health) - Complicated elbow fractures could be added to a growing list of heightened health risks for obese children, according to a recent analysis.

Obese kids were nine times more likely to suffer an elbow fracture with multiple fracture lines in the same arm, or with the bone exposed through the skin, compared to normal-weight children, researchers found. Obese kids were also more likely to have fallen on their outstretched hand.

"As a public health message, this study validates the efforts of medical organizations to raise awareness about childhood obesity," Dr. Michelle Caird told Reuters Health.

"And I think it opens up a conversation about building and maintaining skeletal health," she said. "The skeleton structurally and metabolically supports the human body," she added.

Caird, an orthopedic surgeon, led the study from the University of Michigan C.S. Mott Children's Hospital in Ann Arbor.

She and her team analyzed the health records of 354 children who underwent surgery at that hospital for elbow fractures between 1999 and 2011.

Ninety-two injuries happened on monkey bars or trampolines and 88 fractures occurred from a fall at a standing height.

Additionally, obese kids were more likely to experience nerve palsy post-surgery.

Boys made up a little over half of the sample and patients averaged 6 years old. Most kids in the study were normal weight, but the group included underweight, overweight and obese children.

About 17 percent of American kids could be classified as obese, according to the U.S. Centers for Disease Control and Prevention. The CDC categorizes a child's body mass index (BMI), a measure of weight relative to height, by comparing it to other children in the same age group.

For example, a 6-year-old boy who stands three feet, six inches and weighs 60 pounds would fall in the 99th percentile for his age. This means that 99 percent of kids in the U.S. have a lower BMI. In the current study, kids with a BMI higher than the 95th percentile were considered obese.

The researchers point out in the Journal of Bone & Joint Surgery that their study doesn't delve into the "why" behind complicated elbow fractures in heavy kids.

But past research offers some possible explanations, Caird said. For example, some evidence links high-fat diets with hampering the body's ability to absorb calcium and Vitamin D in the bones. Other studies have suggested that since obese children tend to be more inactive in general, their balance and movement may not be as sharp as normal-weight kids, Caird said.

"There isn't enough data available in the literature to assess whether or not the findings of the current study are representative of the broader national experience," Dr. Marc Michalsky told Reuters Health.

Michalsky, who was not involved in the study, is surgical director of the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital in Columbus, Ohio.

Research on pediatric fractures among obese kids is such a new field that it's difficult to know if the high risk is an expected, low or high statistic, he said.

Besides serving as a reminder of the ongoing U.S. obesity epidemic, the study highlights "significant health differences between obese and non-obese populations," Michalsky said.

Caird pointed out that the best time for growing strong, healthy bone mass is during childhood.

"We can grow bone mass only until we are about 30 years old," she said.

Kids of all sizes who exercise should all follow proper safety precautions when playing sports or being active, like wearing helmets or joint guards, Michalsky said.

"The last thing we want to do is avoid physical activity," he said.

SOURCE: http://bit.ly/1aYJOYj The Journal of Bone & Joint Surgery, online February 5, 2014.

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