Obesity may be a risk factor for recurrent heterotopic ossification in post-traumatic stiff elbow among children and teenagers - 13/05/19

Doi : 10.1016/j.otsr.2019.03.014

Yun Qian ^a,^{^{1
These authors contributed equally to this work.}}, Wenjun Liu ^b,^c,^{^{1
These authors contributed equally to this work.}}, Wei Wang ^b , Cunyi Fan ^a,^b,^⁎
^a Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
^b Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai 201306, China
^c Taishan Medical University, Taian, 271016, China

^⁎Corresponding author at: Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Department of Orthopedics, Shanghai 200233, China.Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Department of OrthopedicsShanghai 200233China

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Abstract

Background

Post-traumatic elbow stiffness and heterotopic ossification (HO) affects long-term life quality, as commonly in children and teenagers as in grownups. Childhood obesity considerably influences public health because it causes stroke, hypertension and diabetes mellitus. Previous research discussed its clinical complications in orthopedic diseases. However, no clinical research reveals the interaction between childhood obesity and HO after elbow injuries.

Hypothesis

Obesity might be a risk factor of recurrent HO after elbow arthrolysis in children and teenagers, correlated with the severity of postoperative HO.

Methods

Fifty seven post-traumatic children and teenagers undergoing elbow arthrolysis were retrospectively reviewed and divided into underweight/normal-weight group (n=28) and overweight/obese group (n=29) according to the gender-specific body mass index (BMI)-for-age growth chart. The Hastings and Graham classification was used to evaluate HO recurrence. We also assessed Mayo elbow performance scores and range of motion.

Results

The mean age, gender, pathogenesis, side of injury, time of injury, follow-up duration were analyzed. Overweight/obese children and teenagers were more likely to develop recurrent HO (p=0.005) than underweight/normal-weight children and teenagers. A significant difference in the severity of recurrent HO between two groups was confirmed (p=0.028). The range of motion was improved greatly in underweight/normal-weight group compared with that in overweight/obese group (p=0.001).

Conclusions

The HO recurrence difference between two groups confirmed the hypothesis. Although underlying mechanisms are unclear, weight control might promote postoperative and long-term rehabilitation of the elbow joint for children and teenagers.