Timely diagnosis of malalignment of the distal extremities is crucial in morbidly obese juveniles

Franz Landauer, Gerda Huber, Katharina Paulmichl, Grace O'Malley, Harald Mangge, Daniel Weghuber, Franz Landauer, Gerda Huber, Katharina Paulmichl, Grace O'Malley, Harald Mangge, Daniel Weghuber

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/m(2) 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.

© 2013 S. Karger GmbH, Freiburg.

Figures

Fig. 1
Fig. 1
Clinical presentation of alignment in morbidly obese children. a Genu valgum. b Abduction setting. c Epiphysiodesis to correct genu valgum (prior to and 17 months after surgery).
Fig. 2
Fig. 2
Algorithm for the orthopedic assessment and treatment of morbidly obese juveniles.
Fig. 3
Fig. 3
Clinical presentation of lower extremity malalignment in obese children prior to closure of epiphyseal plates and treatment consequences.

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