Letters to the Editor   |    
Arabella I. Leet, MD; Carmen P. Pichard, MD; Michael C. Ain, MD
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These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1891-1892
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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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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