Obesity and Paediatric Disorders

The global prevalence of paediatric obesity is rising at an alarming rate and poses many challenges to the field of orthopaedics. This chapter explores the impact of obesity in the field of paediatric orthopaedics, including its impact on bone development, bone metabolism, patterns of injuries, challenges in fracture management, preoperative optimisation, and perioperative risks. Obesity has an impact on lifelong skeletal health. Obese children tend to have a decreased relative bone mass compared to normal-weight children primarily due to the effects of adipose tissue on bone metabolism and vitamin D deficiency. Such a population also has an increased incidence of childhood fractures compared to their normal-weight counterparts, with obesity posing challenges in management. Obese children tend to have more complex fracture patterns, suffer higher degrees of neurovascular complications, and are more difficult to manage in casts than normal-weight children. Furthermore, obesity is a major risk factor for several paediatric orthopaedic conditions, including Blount’s disease, slipped capital femoral epiphysis (SCFE), and Legg–Calvé–Perthes disease. All of these conditions have a significant effect on patient morbidity and can result in long-term musculoskeletal complications. The orthopaedic surgeon must address obesity in the paediatric population, particularly when its effect on musculoskeletal health is considered.