Obesity and long bone fractures in children. Systematic review

Childhood obesity is a pressing global health issue with potential implications for musculoskeletal injury risk and recovery. Although the influence of obesity on bone metabolism is acknowledged, its specific connection to the incidence, patterns, and treatment results of long bone fractures in the pediatric demographic requires further clarification. This systematic review aims to evaluate the existing literature on the relationship between obesity and long bone fractures in children and adolescents, with a focus on fracture risk, anatomical distribution, management approaches, and clinical outcomes. We conducted a systematic literature search of PubMed, MEDLINE, Cochrane Library, and Google Scholar for studies published from January 2000 to March 2025. Search terms included “childhood obesity”, “bone health”, and “long bone fractures”. We included English-language original research that analyzed the relationship between pediatric obesity (BMI ≥ 95th percentile) and long bone fractures. Data on study characteristics, fracture patterns, treatments, and outcomes were extracted. Out of 2,152 articles screened, 14 met the inclusion criteria. Children who were overweight or obese had higher odds of lower extremity fractures, particularly of the tibia and femur (odds ratios 1.5–3.3). Obesity was linked to more complex fracture patterns, including physical involvement and displacement, and a higher failure rate of nonsurgical management, especially for forearm and supracondylar fractures. Operative complications, such as varus deformity and pin-related issues, were more frequent in obese patients. However, no consistent differences were observed between obese and non-obese groups regarding mortality and long-term functional outcomes. Pediatric obesity significantly elevates the risk and complexity of long bone fractures and complicates both nonoperative and surgical management. Acknowledging these challenges is crucial for optimizing treatment and preventing adverse outcomes. Further multicenter prospective studies are needed to clarify the underlying biomechanical and metabolic mechanisms and to guide the development of individualized management protocols. Systematic Review, Level III.