Timely Diagnosis of Malalignment of the Distal Extremities Is Crucial in Morbidly Obese Juveniles

Abstract

Background/Aims: To determine i) whether obesity in childhood can be related to malalignment of the distal extremities, ii) the proportion of genu valgum malalignment and abduction setting, and iii) the respective deviation dominance in children who are morbidly obese. Methods: 31 morbidly obese Caucasian children (16 males) recruited for the STYJOBS Study (ClinicalTrials.gov Identifier NCT00482924) with a mean age of 13.9 ± 0.5 years, a mean height of 162.3 ± 2.7 cm, a mean weight of 90.62 ± 5.0 kg, and a mean BMI of 33.8 ± 1.2 kg/m² were clinically examined using the Mikulicz line in order to assess load distribution on the knee joint. 21 participants received a whole-leg X-ray because of a clinically estimated malalignment. Results: 8/31 participants examined were diagnosed with genu valgum, 1/31 with genu varum, and 22/31 did not have any malalignment of the femur or tibia. The majority of genu valgum presentation was due to femoral deviation. Of those without malalignment, 4/22 participants had an abduction setting, while 2/22 showed an adduction of the leg. Conclusion: Genu valgum as a predominant malalignment of the distal extremities is frequent in youth with morbid obesity. Timely guided correction of angular deformity of the knee seems pivotal in order to avoid osteotomy or osteoarthritis later in life.

Orthopädische Probleme bei Adipositas im Kindes- und Jugendalter

“…In der gleichen Studie konnte bei diesen ein signifikant größerer Valguswinkel im Vergleich zur normalgewichtigen Kontrollgruppe nachgewiesen werden[44]. In einer Untersuchung mit schwer adipösen Jugendlichen von Landauer et al hatten 25,8 % ein Genu valgum[24]. Ebenso sahen de Sa Pinto et al sowie Shultz et al in ihren Beobachtungsgruppen übergewichtiger Jugendlicher eine höhere Prävalenz von X-Beinen[9,42].…”

Orthopedic Problems in Overweight and Obese Children

“…Obese children who are showing signs of valgus kneesshould partake in weight management as early as possible in order to avoid progression to pathological deformity requiring surgical correction. Children who are obese and have suspected pathological malalignment (genu valgum) should undergo a thorough orthopedic assessment at the beginning of puberty [20]. In the case of definite malalignment, referral to a pediatric orthopedic specialist for further evaluation seems mandatory to allow for timely surgical intervention if necessary.…”

“…In the case of definite malalignment, referral to a pediatric orthopedic specialist for further evaluation seems mandatory to allow for timely surgical intervention if necessary. Diagnosis prior to closure of the epiphyseal plate allows for the comparably simple intervention of epiphyseodesis as compared to osteotomy after further maturation of the bones [20].…”

“…These activities constitute an important element of prevention of orthopedic disorders and can try to minimize, at same time, the other medical complication of obesity and the social/financial costs imposed by this problem [21,22]. Moreover, as it is common consensus that timely measures to prevent earlyonset cardiovascular complications of childhood obesity are necessary, as well timely guided correction of angular deformity of the knee seems pivotal in order to avoid osteotomy or osteoarthritis later in life [20].…”

Achsdeformitäten am wachsenden Skelett – diagnostisches Vorgehen

“…Bei übergewichtigen Kindern kann ein Genu valgum, aufgrund der Weichteilhemmung mit vermehrter Abduktion der Oberschenkel, klinisch imposanter aussehen als in der tatsächlichen mechanischen Achsvermessung. Allerdings ist Übergewicht ein bekannter Risikofaktor für Achsabweichungen der unteren Extremität, und eine radiologische Achsenanalyse sollte bei Verdachtsdiagnose durchgeführt werden [22][23][24]. Additiv können im MRT der Knorpelstatus und die Wachstumsfugen beurteilt werden (▶ Abb.…”