Pediatric Elbow Fracture Pattern And Association With Body Mass Index

Abstract

Background: Pediatric fractures around elbow region constitute a large burden of injuries treated in trauma hospitals. Elbow fractures in children make up about 5-10% of all fractures in pediatric patients with distal humeral supracondylar fractures accounting for approximately 60%. The epidemiological profile of elbow fractures in children vary in different regions due to the fact that geographic areas, demographics, climate, social life/structures differ from one part of the world to another. Pediatric obesity has reached epidemic proportions globally. The risk of musculoskeletal injuries is reportedly higher in obese and overweight children as compared with their normal-weight peers. Furthermore, the risk of sustaining forearm fractures especially from low energy mechanisms and chances of sustaining an extremity fracture requiring surgery is higher in obese and overweight children than in the normal-weight counterparts. However, it is unclear what role body mass index plays in fractures about the elbow. Objectives: This study aimed to determine the pattern of pediatric elbow fractures as seen at KNH and to determine the association between pediatric elbow fractures and BMI. Study Design: This was a cross sectional descriptive study. Study site This study was conducted at Kenyatta National hospital casualty, Children‟s orthopedic wards and orthopedic fracture clinics. Methodology; The study population consisted of all children aged fourteen years and below who sustained acute trauma and had a fracture around their elbow. The study had 116 participants. All patients seen over a period of three months (June – Aug 2019) were registered, listed and assigned consecutive numbers. Population census was used. 3 Patients demographics and injury characteristics that included age, sex, height, weight, body mass index, time of injury, upper extremity affected, mechanism of injury, fracture type, place of injury, associated injuries including neurovascular status were recorded in a prepared questionnaire. The primary researcher or his two assistants, qualified orthopedic trauma technologists, collected the data. Height and weight measurements were used to calculate the BMI. The BMI was used to get the patient‟s body mass index percentile for sex and age according to the Centers for Disease Control and Prevention growth chart. A physical exam of the ipsilateral extremity was carried out to determine the elbow injury and associated injuries. Standard anteroposterior and lateral view plain radiographs was used to identify the elbow fracture, associated ipsilateral upper extremity fractures and elbow dislocation. Results 116 participants were recruited. Males were 80(69%).Female were 36(31%).The mean age was 7 years with an age range of 2-14 years. The most common fracture was supracondylar (77%) followed by lateral condyle (7%) and medial epicondyle (6%). Most of the injuries occurred at school 65(56%), followed by home 49(42%).The left elbow (51%) was injured more than the right. The most common mechanism of injury was fall (95%), followed by contact sports (3%). Association between pediatric elbow fractures and BMI was not analyzed due to the low numbers of children in the overweight and obese categories who sustained elbow fractures. Sub analysis of supracondylar humeral fractures and BMI showed more obese children sustained gartland type 3 fractures than the other types (p=0.031) and there was no correlation with BMI. Univariate logistic regression showed a significant correlation between age (p 0.003), sex (p 0.002) and weight (p 0.002) for supracondylar fracture severity. Sex and BMI were not positive covariates on univariate regression. On multivariate logistic regression age, height and weight after controlling for BMI and sex showed no correlation with fracture severity. 4 Conclusion Majority of elbow fractures are supracondylar humeral fractures followed by lateral condyle fractures and medial epicondyle fractures respectively. Majority of the elbow injuries occurred in the school with the most common mechanism of injury being fall from ground level. The peak age of injury is between 3-8 years. Body mass index has no association with pediatric elbow fracture severity.