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Background: Pediatric forearm fractures are common, and the majority are treated with closed reduction and immobilization. Additionally, the incidence of pediatric obesity is rising. Cast index is a useful metric to assess the quality of a cast mold. This study aims to assess the effect of obesity in obtaining an adequate cast index as a predictor for fracture redisplacement and risk for subsequent intervention after a reduction. Methods: A retrospective chart review was conducted over a six-year time period on children with a displaced/unstable forearm fracture that underwent reduction and molded long arm casting with >4 weeks follow-up. The cast index was measured on immediate postmanipulation radiographs. Children were divided into three groups according to body mass index (BMI) percentile for age: Underweight (<5); Normal BMI (5-85); Overweight/obese (≥ 85). Clinical notes and radiographs were reviewed for loss of reduction and secondary intervention. Results: 84 patients (70% male) qualified for inclusion. Mean age was 7.4 years (Range 3-14 years). Fracture redisplacement and secondary intervention occurred in 8 patients (9.5%). Patient BMI distribution was 5% in the Underweight, 71% in the Normal BMI and 24% in the Overweight/obese groups. The mean cast index in the 8 patients who required a second procedure was significantly higher than those who did not (1.00±0.06 vs 0.83±0.07, P<.001). The mean cast index among the underweight, normal BMI and overweight/obese groups was not statistically different. Obesity was not an independent risk factor for secondary

The Role of Obesity on Cast Index and Secondary Intervention in Pediatric Forearm Fractures