Secondary displacement risk after reduction and cast immobilization of displaced distal radius fractures in overweight and obese children: A systematic review and meta-analysis

INTRODUCTION: Childhood obesity is associated to musculoskeletal injures, in particularly with distal radius fracture (DRF). These lesions are the most common fracture in childhood, and the close reduction and casting (CRC) is widely used. The major casting complication is the loss of reduction (LOR). The purpose of this meta-analysis was to statistically compare the studies that investigating reduction loss in obese pediatric DRF, treated with CRC and analyze the available literature and provide an update on the evidence. EVIDENCE ACQUIsITION: Following the Preferred Reporting items for systematic Reviews and Meta-Analyses (PRISMA) guideline, two online medical databases (PubMed and Science Direct) were reviewed. Review Manager 5.4.1 was used to perform the meta-analysis. EVIDENCE SYNTHESIS: Fifteen studies were initially detected, after a proper selection retrospective series 3 article were included in the study. A total of 410 patients were assessed. Forty-three percent of overweight and obese patient treated with nonsurgical management needs an additional intervention contra the 14.1% of normal weight cohort. The LOR total odd ratio in overweight and obese pediatric patients treated with nonsurgical management after DRF was 4.1 (95% CI: 2.36-7.26). CONCLUSIONS: Our study identifies obesity to be a negative risk factor in the treatment of DRF. High BMI patients should undergo to closer clinical follow-up or more aggressive treatment, as percutaneous pinning, to avoid the fracture re-displacement.