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A.I. Leet, C.P. Pichard, and M.C. Ain reply:We appreciate Dr. Lubicky's comments and would like to address his
concerns. Dr. Lubicky believes that in our paper we are addressing our
anecdotal feelings about operating on obese children, yet there are reports in
the current orthopaedic literature that support the idea that complication
rates are greater and operative times are longer for obese adults as compared
with nonobese adults. Jupiter et
al.5 reported
complications related to positioning of heavy limbs during surgery for the
treatment of fracture nonunions in obese patients. Problems with positioning,
combined with an increase in operative time, resulted in nerve palsies,
compartment syndromes, and scalp alopecia. A second study examining the
treatment of femoral fractures in obese adults demonstrated a high rate of
wound dehiscence and thromboembolic disorders complicating
surgery6. Thus, our
aim was to determine whether the same complications and increased operative
times seen in obese adults were occurring in the pediatric population.