ROSEMONT, IL – Healthy bones and joints are the building blocks of a healthy body. With childhood obesity on the rise and a global epidemic declared, the U.S. Bone and Joint Decade points out that obesity can have a devastating impact on a childs musculoskeletal system.
Extra weight adds extra stress to growing bones causing pain and interfering with normal childhood growth and development. Public awareness and education about this growing health issue is a goal of Bone and Joint National Action Week, Oct. 12-20, 2010.
"Families seem to have a better understanding that obesity in children can contribute to heart problems or lead to diabetes, but we fear they’re overlooking the potential impact on their childs joints, muscles and bones," said Paul Esposito, MD, orthopaedic surgeon at Children’s Hospital & Medical Center in Omaha, Neb. "Children are continually growing and their skeletal systems developing. The issues that can result cause significant pain and a risk of disability. In severe cases, surgery may be needed."
Nebraska Child Overcomes Early Challenges
Today, Samantha Stuefer of Lincoln, Neb. is an active and healthy 12-year-old. Her mom describes her as a "good student who loves art, music and singing." As a young child, Samantha spent months in a cast and wheelchairs after developing complications related to weight.
"We noticed the lower part of her leg seemed to bow slightly. Her doctor didn’t think it was anything major but as time went on it seemed to get worse. One day I noticed she was dragging her leg," remembered Brenda Stuefer, Samantha’s mom.
"Samantha developed Infantile Blount’s Disease which is a severe bowing of the legs. In her case, it progressed very rapidly," said Dr. Esposito.
Although bracing the bone can be an effective treatment, Samantha required extensive surgery.
"Without treatment, walking is difficult and debilitating arthritis can result. Nationally, we are seeing more muscle and joint disorders like Blount’s disease in children," Dr. Esposito shared. "It is more common and requires more invasive therapies in significantly overweight children."
A few years later, at the age of six, Samantha developed hip problems. She was diagnosed with slipped capital femoral epiphysis (SCFE) in which the ball part of the hip bone disconnects from the shaft of the thigh bone.
"We would normally see this condition in overweight children during early adolescence. Not only has the incidence doubled over the past 20 years in some parts of the U.S. and the world, but it is occurring at a much younger age than in the past," said Dr. Esposito.
Samantha needed surgery first in one hip, and then the other. Treatment involves placing screws across the growth plate to stabilize the bone and prevent further deformity. The younger the child is, the more likely the screws can interfere with development of the hips.
"Dr. Esposito worried that one of Samantha’s legs might be shorter than the other," said Brenda. "But everything turned out fine. We haven’t noticed any lasting effects." Samantha has achieved a healthy weight. Her mom says she loves to walk and that she makes good decisions about food.
Dr. Esposito says Samantha’s bone health has improved dramatically.
"Despite severe problems as a toddler and child, Samantha has shown that healthy choices pay dividends physically, socially and psychologically. She is now set for many years of good musculoskeletal health," he said.
New York College Student Embraces Active Future
Jawal Awad was an 18 year old college student when he was first referred to Dr. Alice Chu and Dr. David Godfried at the NYU Hospital for Joint Diseases Center for Children for a problem with his left leg that was increasingly limiting his ability to walk and attend classes. Blount’s disease, the orthopaedic condition that leads to this patient’s leg deformity is associated with childhood obesity. Despite efforts to control his weight, including modification of diet and exercise, Jawal struggled with his weight all through his childhood and adolescence.
One year later, referred to NYU Hospital, Jalal underwent a surgical procedure to address his morbid obesity (weight 420 lb). This procedure has traditionally been applied to adults; however, in extreme cases it has been applied to adolescents whose weight places them at risk for numerous other health problems. Jalal had lost 120 pounds since this surgery but continued to have knee pain related to his orthopaedic problem.
The pediatric orthopaedic specialists at the Center for Children worked in collaboration to treat Jalal’s complex bone deformity and associated tear of the medical meniscus knee cartilage. A minimally invasive arthroscopic surgery was performed to treat the meniscal tear and assess remainder of the joint for signs for premature arthritis. Two months later, Dr. Alice Chu performed an exacting orthopaedic surgical procedure, cutting the tibia and fibula bones just below the knee joint and applied a high tech external fixator device that would allow for computer assisted, gradual correction of the bone deformity.
Over the next ardous months, Jalal diligently turned six small bolts attached to the external fixator that gradually straightened his leg, corrected the knee deformity and equalized his leg lengths. Jalal was then allowed to begin walking and the process of rehabilitation begun. X-rays showed steady healing of the bone. A portion of the external fixator was then removed and Jalal was able to return to college classes. After an additional two months of walking with the external fixator in place, the fixator was removed completely.
Jalal is now able to walk distances without having the knee pain he had before surgery. The corrective orthopaedic surgery will also allow him to more easily participate in a fitness program that will be important to his lifetime management of obesity.
"Jalal’s case is an example of how childhood obesity can lead to a serious orthopaedic condition. Fortunately, Jalal recognized all of the issues leading to his Blount’s disease and dealt with them effectively. We were able to correct the leg problem and help him start a lifetime of good exercise habits," said Dr. Chu.
"I have been able to move better and be more productive. I can walk and run longer and be more active in sports. I am even able to play basketball and football. I am in my 3rd year of college and want to be a US Marshall."
National Action Week is observed annually by the U.S. Bone and Joint Decade (USBJD) which is part of the global Bone and Joint Decade, an initiative to raise awareness of musculoskeletal health, stimulate research and improve people’s quality of life. For more information on the USBJD and on National Action Week, please visit www.usbjd.org.
Contact: Toby King