2011
Rosemont, IL - October 19, 2011 - A global epidemic of childhood obesity can have a devastating impact on a child's musculoskeletal system, the U.S. Bone and Joint Initiative says. Because healthy bones and joints are the building blocks of a healthy body, when extra weight stresses growing bones it can cause pain and interfere with normal childhood growth and development.
Growth Plate Problem Linked to Childhood Obesity
Jesus Retana of Los Angeles, California was a heavy child even as a 6 year old. "He has always been pretty active but he eats a lot," said Guadalupe Retana, Jesus' mother.
By age eleven, the growth plate of his upper thigh bone could no longer withstand the stress his extra weight created. After several months of hip pain Jesus was diagnosed with slipped capital femoral epiphysis (SCFE).
This condition arises when the round portion of the hip separates from the shaft of the thigh bone. "It is similar to a scoop of ice cream getting shoved off the cone" explained Dr. Anthony Scaduto, orthopaedic surgeon at Los Angeles Orthopaedic Hospital.
According to the CDC, more than one third of children in the U.S. are either overweight or obese. "The incidence of SCFE has more than doubled in our hospital over the last 20 years" said Dr. Scaduto. "Studies in other regions of the U.S. have also shown children are developing SCFE at an earlier age then they used to, and doctors think this is linked to rising childhood obesity."
In severe cases of SCFE such as Jesus', blood flow to the ball portion of the bone is compromised. This may lead to collapse and destruction of the hip joint causing significant pain and disability.
"I knew his weight could lead to heart problems when he is older but I didn't know it could cause him so much pain and problems now," says Guadalupe. "I am really worried since he can only walk a few blocks."
"Jesus' case is an example of how obesity in childhood can lead to serious and potentially life-long musculoskeletal problems," added Dr. Scaduto. "His rehabilitation will include physical therapy and a specialized weight-loss program focusing on his diet."
"I really want to run again, so I am going to do everything I need to get better," explained Jesus.
Potential Devastating Diagnosis Often Initially Missed
Twelve-year-old Zeshan Askari had limped and experienced intermittent left knee pain for several months before he was diagnosed with slipped capital femoral epiphysis (SCFE). Patients with SCFE often have symptoms at the knee according to Dr. Howard Epps, the pediatric orthopaedic surgeon in Houston who cared for Zeshan. "Problems in the hip can cause pain anywhere from the hip down to the knee, and unfortunately this can lead to delayed diagnosis when doctors just focus on the knee," Epps explained. "I had no idea that knee pain meant he had a problem with his hip," said Asiya Askari, Zeshan's mother.
When Zeshan slipped and fell on a waterslide one weekend, the pain became more severe and localized to his hip. Zeshan's parents took him to the emergency room at Texas Children's Hospital where doctors made the diagnosis and Dr. Epps surgically stabilized Zeshan's hips. Three weeks out from surgery Zeshan's pain has almost resolved and he will soon be off his crutches.
Zeshan and his parents have been told that this is not the end of the story. "When the diagnosis is made later, children with SCFE have more significant deformity of the hip," said Dr. Epps. "It's possible that he may need more surgery in the future to return to full function," he added.
The Askari's experience had motivated them to address Zeshan's weight. "We are really trying to monitor the types of foods that Zeshan eats because we know his weight is a problem," said Ali Askari, Zeshan's father. "Exercise will be an important part of Zeshan's weight loss program," Epps added, "but we need to get his hips healed first."
Given the importance of early surgery, the U.S. Bone and Joint Initiative is emphasizing early recognition of slipped capital femoral epiphysis during Bone and Joint Health National Awareness Week, Oct. 12-20, 2011.
Bone and Joint Health National Awareness Week aims to raise awareness of musculoskeletal health, stimulate research and improve quality of life. For more information, please follow the link.
2010
A global epidemic of childhood obesity can have a devastating impact on a child's musculoskeletal system, the U.S. Bone and Joint Initiative (formerly know as the United States Bone and Joint
Decade says "because healthy bones and joints are the building blocks of a healthy body, when extra weight stresses growing bones it can cause pain and interfere with normal childhood growth and development."
"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 child's joints, muscles and bones," says Paul Esposito, MD, orthopaedic surgeon at Children's Hospital & Medical Center in Omaha, Neb.
"Nationally, we are seeing more muscle and joint disorders like Blount's disease in children. It is more common and requires more invasive therapies in significantly overweight children," says Dr. Esposito. "Children are continually growing and their skeletal systems developing. The issues that can result cause significant pain and a risk of disability."
Creating public awareness and education about this growing health issue is a goal of Bone and Joint National Awareness Week, Oct. 12-20, 2010.
Nebraska Child Overcomes Early Challenges
Today, Samantha Stuefer of Lincoln, Neb. is an active, healthy 12-year-old. Samantha is a "good student who loves art, music and singing," says her mom. Yet, as a young child, Samantha spent months in a cast and wheelchairs after developing complications related to her 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," recalls Brenda Stuefer, Samantha's mom. "One day I noticed she was dragging her leg."
Samantha developed Infantile Blount's Disease which is a severe bowing of the legs, an orthopaedic condition that leads to leg deformity associated with childhood obesity. Bracing the bone can be an effective treatment, but Samantha required extensive surgery.
"In her case, it progressed very rapidly," says Dr. Esposito. "Without treatment, walking is difficult and debilitating arthritis can result."
In Samantha's case, she developed hip problems at the age of six. 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," says Dr. Esposito. "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."
Samantha needed surgery first in one hip, then the other. Treatment involves placing screws across the growth plate to stabilize the bone and prevent further deformity. The younger the child, 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," says Brenda. "But everything turned out fine. We haven't noticed any lasting effects."
Samantha has achieved a healthy weight. Her mom says that she loves to walk and 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," he says. "She is now set for many years of good musculoskeletal health."
New York College Student Embraces Active Future
Jalal Awad was an 18-year old college student when a problem with his left leg was gradually limiting his ability to walk and attend classes. He was referred to Dr. Alice Chu and Dr. David Godfried at the NYU Hospital for Joint Diseases Center for Children.
Jalal also has Blount's disease, the orthopaedic condition that leads to leg deformity and is associated with childhood obesity. Despite efforts to control his weight, including modification of diet and exercise, Jawal struggled with his weight through his childhood and adolescence.
At NYU Hospital, Jalal underwent a surgical procedure to address his morbid obesity (he weighed 420 pounds). Traditionally used for adults, the procedure has been applied to adolescents in extreme cases when their weight puts them at risk for other health problems. Jalal has lost 120 pounds since this surgery but continued to have knee pain related to his orthopaedic issues.
Pediatric orthopaedic specialists at the Center for Children collaborated 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 the remainder of the joint for premature arthritis. Two months later, Dr. Chu performed an orthopaedic surgical procedure, cutting the tibia and fibula bones just below the knee joint and applying a high-tech external fixator device that would allow a computer-assisted, gradual correction of the bone deformity.
Over the next several months, Jalal diligently turned six small bolts attached to the external fixator which 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 another two months of walking with the external fixator, the device was completely removed.
Today, Jalal is able to walk distances without the knee pain he had prior to surgery. The corrective orthopaedic surgery will also allow him to participate more easily 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," says Dr. Chu. "Fortunately, Jalal recognized all 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."
"I have been able to move better and be more productive. I can walk and run longer and be more active in sports," says Jalal. "I am even able to play basketball and football. I am in my 3rd year of college and want to be a U.S. Marshall."
National Awareness Week (Oct. 12-20) is observed annually by the U.S. Bone and Joint Initiative (USBJI) formerly known as the United States Bone and Joint Decade 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 USBJI and on National Awareness Week, please visit www.usbji.org.
|
