1
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Crain NA, Cohen GM, Ravish ME, Skelton JA. Success of topiramate to slow progression of Blount disease in a toddler: A case study. Radiol Case Rep 2024; 19:5308-5312. [PMID: 39280740 PMCID: PMC11399791 DOI: 10.1016/j.radcr.2024.07.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/18/2024] Open
Abstract
Rates of Blount disease and childhood obesity have increased in parallel, although the co-management of this acquired comorbidity and obesity is not well described. This report shares the course of a toddler with severe obesity who experienced rapid and persistent weight gain without success from nutrition and behavior changes. After repeat subspeciality evaluation, the patient was ultimately diagnosed with signs of early-onset Blount disease, urging the need for adjunct medical therapy. Initiation of topiramate was shown to achieve weight neutrality and improve the patient's body mass index (BMI), appearing to halt the progression of Blount disease and avoiding escalation to surgical treatment. This report suggests topiramate can be an effective and well-tolerated medication in young patients with a pressing need for weight intervention.
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Affiliation(s)
- Nikhil A Crain
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gail M Cohen
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Matthew E Ravish
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Orthopedics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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2
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Waldrop SW, Ibrahim AA, Maya J, Monthe-Dreze C, Stanford FC. Overview of Pediatric Obesity as a Disease. Pediatr Clin North Am 2024; 71:761-779. [PMID: 39343491 PMCID: PMC11443063 DOI: 10.1016/j.pcl.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
The authors highlight well-known and hypothesized pathophysiologic mechanistic links underlying obesity and the various pediatric disorders across multiple organ systems with which it is associated. Obesity is attributed to an imbalance in energy intake versus expenditure; there is growing knowledge regarding its multifactorial origins, dysfunctional physiologic processes, and adverse health consequences. Individuals with obesity exhibit variations in metabolic rate, genetic predisposition, and hormonal regulation, influencing diverse responses in regulating energy balance. Understanding the complex mechanistic relationships surrounding the pathophysiology of obesity assists in its consideration as a disease process, allowing pediatric health practitioners to manage its sequelae more effectively.
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Affiliation(s)
- Stephanie W Waldrop
- Section on Nutrition, Department of Pediatrics, Anschutz Medical Campus, Nutrition Obesity Research Center (NORC), University of Colorado, Aurora, CO, USA.
| | - Awab Ali Ibrahim
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Jacqueline Maya
- Department of Pediatrics, Division of Pediatric Endocrinology, MGH Weight Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02115, USA
| | - Carmen Monthe-Dreze
- Division of Newborn Medicine, Department of Pediatrics, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Fatima Cody Stanford
- Division of Endocrinology-Neuroendocrine, Department of Medicine, Massachusetts General Hospital, MGH Weight Center, 50 Staniford Street, Suite 430, Boston, MA 02115, USA; Department of Pediatrics, Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA. https://twitter.com/askdrfatima
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3
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Weedn AE, Benard J, Hampl SE. Physical Examination and Evaluation for Comorbidities in Youth with Obesity. Pediatr Clin North Am 2024; 71:859-878. [PMID: 39343498 DOI: 10.1016/j.pcl.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Obesity is a complex and chronic disease that can affect the entire body. The review of systems and physical examination are important components of the evaluation. Laboratory assessment is directed toward known cardiometabolic comorbidities. Regular follow-up visits with repeated review of systems, physical examination, and laboratory testing can facilitate early detection and management of comorbidities of this chronic disease.
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Affiliation(s)
- Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, Suite 12400, Oklahoma City, OK 73104, USA
| | - Julie Benard
- Cape Physician Associates, Saint Francis Healthcare System, 211 Saint Francis Drive, Cape Girardeau, MO 63703, USA
| | - Sarah E Hampl
- Children's Mercy Kansas City, Center for Children's Healthy Lifestyles & Nutrition, 2401 Gillham Road, Kansas City, MO 64108, USA.
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4
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Kelly AS, Armstrong SC, Michalsky MP, Fox CK. Obesity in Adolescents: A Review. JAMA 2024; 332:738-748. [PMID: 39102244 DOI: 10.1001/jama.2024.11809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Importance Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood. Observations Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research. Conclusions and Relevance The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.
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Affiliation(s)
- Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis
| | - Sarah C Armstrong
- Department of Pediatrics, Department of Population Health Sciences, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Durham, North Carolina
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus
| | - Claudia K Fox
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis
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5
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Depaoli A, Ramella M, Menozzi GC, Di Gennaro GL, Rocca G, Trisolino G. Opening-Wedge High Tibial Osteotomy with a Cancellous Strut Bone Allograft Is Inadequate for Achieving Satisfactory and Lasting Correction in Neglected Infantile Tibia Vara: Results from a Cohort of 29 Patients. J Clin Med 2024; 13:4261. [PMID: 39064301 PMCID: PMC11278200 DOI: 10.3390/jcm13144261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Infantile tibia vara (ITV) is a rare proximal tibia deformity in infancy, leading to progressive knee varus. High tibial osteotomy is commonly practiced but has high recurrence rates. This study analyzed factors affecting treatment failure and recurrence in children undergoing opening-wedge high tibial osteotomy (OWHTO) for ITV. Methods: We retrospectively studied children with ITV who had OWHTO with a press-fit cancellous bone allograft between 2000 and 2020, with ≥2-year follow-up. Outcomes included recurrence (knee varus with tibiofemoral angle > 10°), complications, and reintervention. Results: We analyzed 39 knees in 29 patients (mean age: 4.8 ± 1.9 years; median follow-up: 7.4 years). Recurrence occurred in 22 cases (56%). Age at surgery significantly influenced recurrence, with rates of 16% before age 5 versus 95% later (hazard ratio: 12.0, p = 0.001). Langenskiöld stage also affected recurrence (β-coefficient: 2.7, 95% C.I. 1.0-4.5, p = 0.002; pseudo-R-squared: 0.50, p = 0.001), with recurrence in all stage IV or higher cases. Conclusions: Early diagnosis and treatment before age 5, ideally with Langenskiöld stage III or lower, are crucial for stable correction with OWHTO alone. Late, high-grade ITV may require combined, acute or gradual, and/or staged correction. Further evidence is needed for optimal management.
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Affiliation(s)
- Alessandro Depaoli
- Rizzoli Sicilia Department, IRCCS Istituto Ortopedico Rizzoli, 90011 Bagheria, Italy;
| | - Marco Ramella
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Grazia Chiara Menozzi
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Luigi Di Gennaro
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gino Rocca
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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6
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Longo UG, Mazzola A, Campi S, Salvatore G, Candela V, Casciaro C, Giannarelli D, D’Hooghe M, Papalia R. Annual Trends of High Tibial Osteotomy: Analysis of an Official Registry in Italy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1168. [PMID: 39064599 PMCID: PMC11279272 DOI: 10.3390/medicina60071168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50-54, 55-59 showed the higher number of procedures. In pediatric patients (0-19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were "Varus knee" (736.42 ICD-9-CM code, 33.9%), "Osteoarthrosis, localized, primary, leg region" (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20-24 age class to the 50-54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Giuseppe Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Carlo Casciaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Margaux D’Hooghe
- Department of Medicine, University of Navarra, 31008 Pamplona, Spain;
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (A.M.); (S.C.); (G.S.); (V.C.); (C.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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7
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Raftis D, Helbing J, Dance S, O'Mara A, Tabaie S. Tension-Band Plating for Infantile Blount Disease: Efficacy and Outcomes Comprehensive Review. Cureus 2024; 16:e62514. [PMID: 38887744 PMCID: PMC11181882 DOI: 10.7759/cureus.62514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/20/2024] Open
Abstract
Infantile Blount disease (IBD) is a pathologic varus knee deformity that, if left untreated, can lead to abnormal gait, limb length discrepancy, and pain. Traditionally, bracing and tibial osteotomy have been the primary treatments. More recently, guided growth with tension-band plating (TBP) has gained popularity, although there is a lack of data stratifying between the infantile, juvenile, and adolescent disease types. Therefore, the present review aims to determine the efficacy and complications of TBP in the IBD population. A systematic review was conducted following the PRISMA guidelines. Eligible studies included those focused on guided growth correction for IBD. Studies that did not stratify subjects by subgroup (infantile, juvenile, and adolescent) within their analysis were excluded. The outcomes of interest included demographic information, correction rate, failure rate, recurrence rate, and postoperative complications. Database review identified 541 studies. After screening, seven studies met our inclusion criteria, all of which were retrospective observational studies published between 2012 and 2022. In total, 92 limbs afflicted with Infantile Blount Disease underwent treatment with TBP. The recorded follow-up period ranged from four months to eight years. The age of patients at the time of surgery varied from 1.8 to nine years. On average, there was a 78.99% correction of deformities, with a range of 57.14% to 100%. Six studies provided data on failure and recurrence rates, with an average rate of 23.47%. Notably, infection and hardware failure emerged as the most prevalent postoperative complications, with mean rates of 11.44% and 9.50%, respectively. The average reoperation rate was 29.90%, with a range from 0.00% to 47.06%. The current literature shows a high rate of deformity correction with a relatively low risk of complications after TBP for IBD. Given the reported reoperation rates greatly varied, further data is needed to determine risk factors for reoperation following TBP. Our results suggest that guided growth with TBP may be a preferable first-line treatment for IBD.
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Affiliation(s)
- Daniel Raftis
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Jordan Helbing
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah Dance
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
| | - Alana O'Mara
- Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sean Tabaie
- Orthopaedic Surgery, Children's National Hospital, Washington DC, USA
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8
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Benes G, Ghanem D, Badin D, Greenberg M, Honcharuk E. The Effect of Socioeconomic Deprivation on Radiographic Deformities in Children With Blount Disease. J Pediatr Orthop 2024; 44:254-259. [PMID: 38158726 DOI: 10.1097/bpo.0000000000002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Blount disease can occur at any time during the growth process, primarily with a bimodal distribution in children younger than 4 years old and adolescents. The disease process most commonly presents in Black adolescents, with disease severity positively correlated with obesity. Given the known associations among race, obesity, and socioeconomic status, we investigated the relationship between the degree of social deprivation and severity of lower extremity deformities among a community-based cohort with Blount disease. METHODS A retrospective review of hospital records and radiographs of patients with previously untreated Blount disease was conducted. Patients were classified as having early-onset or late-onset Blount disease based on whether the lower limb deformity was noted before or after the age of 4 years. The area deprivation index (ADI), a nationally validated measure that assesses socioeconomic deprivation by residential neighborhood, was calculated for each patient as a surrogate for socioeconomic status. Higher state (range: 1 to 10) or national (range: 1 to 100) ADI corresponds to increased social deprivation. Full-length standing radiographs from index clinic visits were evaluated by 2 reviewers to measure frontal plane deformity. The association of ADI with various demographic and radiographic parameters was then analyzed. RESULTS Of the 65 patients with Blount disease, 48 (74%) children were Black and 17 (26%) were non-black children. Nineteen children (32 limbs) had early-onset and 46 children (62 limbs) had late-onset disease. Black patients had significantly higher mean state (7.6 vs. 5.4, P =0.009) and national (55.1 vs. 37.4, P =0.002) ADI values than non-black patients. Patients with severe socioeconomic deprivation had significantly greater mechanical axis deviation (66 mm vs. 51 mm, P =0.008). After controlling demographic and socioeconomic factors, the results of multivariate linear regression showed that only increased body mass index (β=0.19, 95% CI: 0.12-0.26, P <.001) and state ADI (β=0.021, 95% CI: 0.01-0.53, P =.043) were independently associated with greater varus deformity. CONCLUSIONS Socioeconomic deprivation was strongly associated with increased severity of varus deformity in children with late-onset Blount disease. Our analysis suggests that obesity and socioeconomic factors are the most influential with regard to disease progression. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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9
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Liang W, Zhou C, Bai J, Zhang H, Jiang B, Wang J, Fu L, Long H, Huang X, Zhao J, Zhu H. Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends. Front Bioeng Biotechnol 2024; 12:1328997. [PMID: 38405378 PMCID: PMC10884185 DOI: 10.3389/fbioe.2024.1328997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Recent advancements in orthopedic surgery have greatly improved the management of musculoskeletal disorders and injuries. This review discusses the latest therapeutic approaches that have emerged in orthopedics. We examine the use of regenerative medicine, including stem cell therapy and platelet-rich plasma (PRP) injections, to accelerate healing and promote tissue regeneration. Additionally, we explore the application of robotic-assisted surgery, which provides greater precision and accuracy during surgical procedures. We also delve into the emergence of personalized medicine, which tailors treatments to individual patients based on their unique genetic and environmental factors. Furthermore, we discuss telemedicine and remote patient monitoring as methods for improving patient outcomes and reducing healthcare costs. Finally, we examine the growing interest in using artificial intelligence and machine learning in orthopedics, particularly in diagnosis and treatment planning. Overall, these advancements in therapeutic approaches have significantly improved patient outcomes, reduced recovery times, and enhanced the overall quality of care in orthopedic surgery.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiangwei Wang
- Medical Research Center, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Lifeng Fu
- Department of Orthopedics, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Xiaogang Huang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Haibing Zhu
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
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10
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Miraj F, Karda IWAM, Erwin US, Pratama IK. Can acute correction with simultaneous hemiepiphysiodesis of lateral proximal tibia physis prevent recurrence in neglected infantile Blount's disease? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:529-537. [PMID: 37642701 DOI: 10.1007/s00590-023-03699-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The treatment of infantile Blount's disease usually includes surgical correction, but high recurrence is still a problem regardless of the procedure. We conducted a cross-sectional study of severely neglected infantile Blount's disease treated with acute correction and simultaneous hemiepiphysiodesis of lateral proximal tibia physis. In this study, we aimed to observe the complication and recurrence. METHODS This research is an analytical study with a cross-sectional design using retrospective data collection and total sampling. The subjects were patients with neglected infantile Blount's disease treated from 2018 to 2023 in our institution. Follow-up was conducted in 6, 12, 24, and 36 months. RESULTS A total of 25 legs from twenty patients were recorded. We observed three legs (12.0%) had recurrence. No neurovascular complications and infections were observed. All subjects had significant postoperative improvement of TFA (mean 6.8 ± 0.730 valgus), Drennan angle, MPTA, MTPD, JLCA, and ligamentous laxity grading (p < 0.001). Lower than 5° postoperative valgus overcorrections and preoperative physeal bar were significant factors in patients with recurrence (p = 0.020 and p = 0.010). There was no significant increase in leg-length discrepancy during follow-up (p = 0.052). There were no significant differences between age, BMI, preoperative TFA, pre- and postoperative Drennan angle, MPTA, MTPD, JLCA, Langenskiöld stages, and length of follow-up in patients with recurrence and not. CONCLUSION Acute correction with simultaneous hemiepiphysiodesis of lateral proximal tibia physis is an effective technique to prevent deformity recurrence in neglected infantile Blount's disease, provided that the postoperative TFA is more than 5° of valgus and no evidence of physeal bar in the preoperative radiograph.
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Affiliation(s)
- Faisal Miraj
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine Universitas Indonesia, RS. Fatmawati Raya St. No. 4, South Jakarta, 12430, Indonesia.
| | - I Wayan Arya Mahendra Karda
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine Universitas Indonesia, RS. Fatmawati Raya St. No. 4, South Jakarta, 12430, Indonesia
| | - Uno Surgery Erwin
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine Universitas Indonesia, RS. Fatmawati Raya St. No. 4, South Jakarta, 12430, Indonesia
| | - Irfan Kurnia Pratama
- Department of Orthopaedic and Traumatology, Fatmawati Central General Hospital, Faculty of Medicine Universitas Indonesia, RS. Fatmawati Raya St. No. 4, South Jakarta, 12430, Indonesia
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11
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Ramella M, Depaoli A, Menozzi GC, Gallone G, Cerasoli T, Rocca G, Trisolino G. Recurrence and Complication Rates of Surgical Treatment for Blount's Disease in Children: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6495. [PMID: 37892633 PMCID: PMC10607610 DOI: 10.3390/jcm12206495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Blount's disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. METHODS A systematic review was conducted of studies published before January 2022. RESULTS In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. CONCLUSIONS Overall, poor evidence with which to establish an optimal treatment for Blount's disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases.
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Affiliation(s)
| | | | | | | | | | | | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.R.); (A.D.)
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12
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Güven E, Çıtaker S, Alsancak S. The effect of orthotics on plantar pressure in children with infantile tibia vara (Blount's disease). Sci Rep 2023; 13:2875. [PMID: 36804454 PMCID: PMC9938851 DOI: 10.1038/s41598-023-30066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/15/2023] [Indexed: 02/20/2023] Open
Abstract
Albeit some studies have revealed the effectiveness of the orthosis use in infantile tibia vara (ITV), hitherto no study has shown the effects of these orthosis on plantar pressures. This study aims to reveals the effects of orthosis on plantar pressure in infantile tibia vara. Fourteen children (mean age: 27.14 ± 5.00 months) with infantile tibia vara made up the study group and 14 healthy children (mean age: 26.42 ± 5.33 months) constituted the control group. The plantar pressure distribution was evaluated with WALKINSENSE. ITV group was evaluated before and after orthosis. The control group did not use orthosis and was evaluated once. After orthosis, it was determined that lateral foot pressure decreased, and medial foot pressure increased in the hindfoot. After orthosis, medial pressure decreased in the forefoot (p < 0.05). The pressure in the forefoot of the control group was significantly higher than that in the ITV group (before and after orthosis) (p < 0.05). After orthosis, the pressure was similar in the posterior and mid-foot sensors between the ITV group and the control group (p˃0.05). The orthosis can be effective in achieving the normalization of the soles pressure distribution in children with ITV.
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Affiliation(s)
- Enver Güven
- Faculty of Health Sciences, Department of Prosthetics and Orthotics, Ankara University, Ankara, 06290, Turkey.
| | - Seyit Çıtaker
- grid.25769.3f0000 0001 2169 7132Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, 06490 Turkey
| | - Serap Alsancak
- grid.7256.60000000109409118Faculty of Health Sciences, Department of Prosthetics and Orthotics, Ankara University, Ankara, 06290 Turkey
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13
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Kolbe N, Haydon F, Kolbe J, Dreher T. Single-Stage Tibial Osteotomy for Correction of Genu Varum Deformity in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020377. [PMID: 36832505 PMCID: PMC9955771 DOI: 10.3390/children10020377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
Conservative and operative treatments with gradual or acute correction of severe varus deformities of the leg have been described. We evaluated whether the corrective osteotomy used within the NGO Mercy Ships is an effective treatment for genu varum deformity of different etiologies in children and which patient specific factors have an influence on the radiographic outcome. In total, 208 tibial valgisation osteotomies were performed in 124 patients between 2013 and 2017. The patients' mean age at the time of surgery was 8.4 (2.9 to 16.9 (min/max)) years. Seven radiographically measured angles were used to assess the deformity. Clinical photographs taken pre- and postoperatively were assessed. The mean time between the surgery and the end of physiotherapeutic treatment was 13.5 (7.3 to 28) weeks. Complications were monitored and classified according to the modified Clavien-Dindo-classification system. The mean preoperative mechanical tibiofemoral angle was 42.1° varus (range: 85°-12° varus). The mean postoperative mechanical tibiofemoral angle was 4.3° varus (range: 30° varus-13° valgus). The factors predicting a residual varus deformity were higher age, greater preoperative varus deformity and the diagnosis of Blount disease. The tibiofemoral angle measured on routine clinical photographs correlated well with the radiographic measurements. The single-stage tibial osteotomy described is a simple, safe and cost-effective technique to correct three-dimensional deformities of the tibia. Our study shows very good mean postoperative results, but with a higher variability than in other studies published. Nevertheless, considering the severity of preoperative deformities and the limited opportunities for aftercare, this method is excellent for the correction of varus deformities.
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Affiliation(s)
- Nikolas Kolbe
- Department of Orthopedics and Traumatology, University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Frank Haydon
- Orthopedic Surgeon, NGO Mercy Ships, 1012 Lausanne, Switzerland
| | - Johannes Kolbe
- Orthopedic Surgeon, NGO Mercy Ships, 1012 Lausanne, Switzerland
| | - Thomas Dreher
- Head of Pediatric Orthopedic and Trauma Surgery, Children’s University Hospital Zürich, 8032 Zürich, Switzerland
- Head of Pediatric Orthopedics, Orthopedic University Hospital Balgrist, 8008 Zürich, Switzerland
- Correspondence: ; Tel.: +41-442667535
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14
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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15
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Tisano B, Anigian K, Kantorek N, Kenfack YJ, Johnson M, Brooks JT. The Insidious Effects of Childhood Obesity on Orthopedic Injuries and Deformities. Orthop Clin North Am 2022; 53:461-472. [PMID: 36208888 DOI: 10.1016/j.ocl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The current childhood obesity epidemic, affecting approximately 20% of American children and adolescents, is accompanied by unique orthopedic manifestations. The growing musculoskeletal system is susceptible to the endocrine effects of obesity, resulting in decreased bone mass and quality. As a result, obese children are at increased risk of musculoskeletal injury, fracture, and lower extremity deformities. The efficacy of nonoperative treatment such as casting or bracing may be limited by body habitus and surgical treatment is accompanied by increased risk of perioperative complications.
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Affiliation(s)
- Breann Tisano
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Kendall Anigian
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Nyssa Kantorek
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Yves J Kenfack
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Megan Johnson
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA.
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16
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Schultz K, Stüwe D, Westhoff B. [Juvenile osteochondrosis and osteonecrosis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:829-843. [PMID: 36064862 DOI: 10.1007/s00132-022-04305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Juvenile osteonecrosis is an important topic in orthopedics. A wide variety of body regions of the growing patient are affected, predominantly during adolescence. All are characterized by a usually unknown aetiology as well as a stadium-like course. The main problem is a local osseous circulatory disorder, which causes osteonecrosis. RISK FACTORS Mechanical overloading due to increased body weight, axial misalignment, and sports activity is discussed as a risk factor. Healing depends on the localization and extent of the osseous necrosis. DIAGNOSTICS Diagnostically, radiologic imaging is used, in which the typical bony remodeling can be followed. THERAPY The therapeutic procedure depends on the affected region but is usually accompanied by a reduction of mechanical loading. If the clinical and radiological findings worsen, surgical treatment must be considered. The recognition and treatment of juvenile osteonecrosis is important and significantly influences the further development of the patient.
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Affiliation(s)
- Katharina Schultz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Dominique Stüwe
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Bettina Westhoff
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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17
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Cuda SE, Kharofa R, Williams DR, O'Hara V, Conroy R, Karjoo S, Paisley J, Censani M, Browne NT. Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100031. [PMID: 37990723 PMCID: PMC10662000 DOI: 10.1016/j.obpill.2022.100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age. Conclusions This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Valerie O'Hara
- WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, Pediatric Gastroenterology, 501 6th Ave S St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street, Lawrenceburg, IN, 47025-2048, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
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18
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Abstract
Purpose Blount disease is most common among obese Black children. The reason for Blount's racial predisposition is unclear. Given that obesity is a risk factor for Blount disease and the known associations between race, obesity, and socioeconomic status in the United States, we hypothesized that socioeconomic status and severity of obesity differ between Black and non-Black children with late-onset Blount disease. We additionally examined differences in treatment types between Black and non-Black children. Methods One hundred twenty-five patients from two institutions were included. Age at presentation, age of onset, body mass index, race, sex, and treatment type were recorded. These variables were compared between Black and non-Black children. Insurance type and estimated household income were used as markers of socioeconomic status. Results Of the 125 patients with late-onset Blount disease, body mass index percentiles were higher for Black patients (96th ± 12th percentile) than non-Black patients (89th ± 22nd percentile) (p = 0.04). Black patients also had lower estimated incomes (US$48,000 ± US$23,000 vs US$62,000 ± US$30,000) (p = 0.01) and much higher rates of Medicaid enrollment (69% vs 24%) (p < 0.01) than did non-Black patients. Regarding treatment types, osteotomy was more common among Black patients (60%) than non-Black patients (38%) (p = 0.033). Conclusion The race-related associations we found between obesity and socioeconomic status suggest that non-genetic factors may contribute to observed racial differences in the prevalence of Blount disease. Level of evidence level III.
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Affiliation(s)
- Walter Klyce
- Department of Orthopaedic Surgery, Case
Western Reserve University, Cleveland, OH, USA
- Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - Daniel Badin
- Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - Jigar S Gandhi
- Department of Orthopaedic Surgery,
Cooper University Hospital, Camden, NJ, USA
- Division of Orthopaedics, Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Jay Lee
- Division of Pediatric Orthopaedics,
Johns Hopkins Children’s Center, The Johns Hopkins University, Baltimore, MD,
USA
| | - B David Horn
- Division of Orthopaedics, Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Honcharuk
- Department of Orthopaedic Surgery, The
Johns Hopkins University, Baltimore, MD, USA
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19
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Coppa V, Marinelli M, Procaccini R, Falcioni D, Farinelli L, Gigante A. Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment. World J Orthop 2022; 13:427-443. [PMID: 35633744 PMCID: PMC9124997 DOI: 10.5312/wjo.v13.i5.427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/02/2021] [Accepted: 04/09/2022] [Indexed: 11/09/2022] Open
Abstract
Coronal plane deformity around the knee, also known as genu varum or genu valgum, is a common finding in clinical practice for pediatricians and orthopedists. These deformities can be physiological or pathological. If untreated, pathological deformities can lead to abnormal joint loading and a consequent risk of premature osteoarthritis. The aim of this review is to provide a framework for the diagnosis and management of genu varum and genu valgum in skeletally immature patients.
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Affiliation(s)
- Valentino Coppa
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Mario Marinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Roberto Procaccini
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Danya Falcioni
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona 60121, Italy
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20
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Blount Disease. J Belg Soc Radiol 2021; 105:51. [PMID: 34622139 PMCID: PMC8462473 DOI: 10.5334/jbsr.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Teaching point: MRI allows to assess deformity and viability of the tibia in Blount disease.
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21
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Cerqueira FDS, Motta GATA, Rocha de Faria JL, Pizzolatti IS, Motta DPD, Mandarino M, Kropf LAL, Cerqueira FDS. Controlled Double Gradual Opening Osteotomy for the Treatment of Severe Varus of the Knee-Blount's Disease. Arthrosc Tech 2021; 10:e2199-e2206. [PMID: 34504761 PMCID: PMC8417508 DOI: 10.1016/j.eats.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
Varus deformity of the knee can lead to early degeneration of the medial tibiofemoral joint. Pediatric patients can be pathologically affected with this deformity known as Blount disease. The cause of this pathology is still uncertain, but some risk factors are well established, such as obesity and family history. The diagnosis is made through clinical history, physical examination, and the radiographic analysis after the age of 2.5 years. The analysis of the metaphyseal-diaphyseal angle, described by Levine and Drennan, is also commonly used for prognosis. When this angle is greater than 16°, it is considered to be grossly abnormal. Possible options for correcting the generated angular deformity are epiphysiodesis, osteotomy (acute or gradual correction), and gradual correction by distraction of the physis. In this surgical technique, we performed a double tibial osteotomy with controlled gradual opening using monolateral external fixator (Orthofix, Verona, Italy). Our technique proved to be an effective way to correct the adolescent tibia vara and is practical and reproducible. Moreover, the use of gradual opening osteotomy allowed a more accurate outcome.
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Affiliation(s)
- Flavio dos Santos Cerqueira
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | | | - José Leonardo Rocha de Faria
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil,Address correspondence to José Leonardo Rocha de Faria, M.D., M.Sc., Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil. CEP: 20940-070.
| | | | - Diego Perez da Motta
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
| | - Marcelo Mandarino
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | - Fernando dos Santos Cerqueira
- Dysmetria and Deformities Center of National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, Brazil
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22
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Taylor AJ, Carpenter W, Runner RP. Staged Bilateral Total Knee Arthroplasty for Neglected Blount Disease Using a Gap Balancing Technique. Arthroplast Today 2021; 11:25-31. [PMID: 34430686 PMCID: PMC8368345 DOI: 10.1016/j.artd.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022] Open
Abstract
Blount disease is an acquired, asymmetrical disorder of proximal tibial growth that results in a complex three-dimensional proximal tibial deformity, with tibial varus being the dominating feature. Although the exact pathophysiology is unknown, Blount disease is separated into 2 clinical variants, infantile and adolescent, based on the onset of symptoms occurring before or after the age of 10 years. If recognized and treated early, affected patients generally have a favorable prognosis; however, if neglected, it can lead to progressive malalignment and premature osteoarthritis. We present a patient with bilateral neglected Blount disease who underwent successful bilateral total knee arthroplasty performed in a staged fashion using a gap balancing technique with constrained condylar knee implants.
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Affiliation(s)
- Adam J Taylor
- Department of Orthopaedic Surgery, Harbor-University of California, Los Angeles, Medical Center, Torrance, CA.,Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - William Carpenter
- Joint Replacement Center, Tennessee Orthopedic Alliance, Nashville, TN
| | - Robert P Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA
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23
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Robbins CA. Deformity Reconstruction Surgery for Blount's Disease. CHILDREN (BASEL, SWITZERLAND) 2021; 8:566. [PMID: 34209445 PMCID: PMC8303124 DOI: 10.3390/children8070566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Blount's disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount's disease is often bilateral and affects children in the first few years of life. Late-onset Blount's disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4-10), and adolescent tibia vara (ages 11 and older). Early-onset Blount's disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient's age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount's disease.
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Affiliation(s)
- Craig A Robbins
- Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, USA
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24
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Kita T, Tajima T, Chosa E. Turner's syndrome associated with discoid lateral meniscus and Blount's disease: a case report. BMC Musculoskelet Disord 2021; 22:449. [PMID: 33992118 PMCID: PMC8126072 DOI: 10.1186/s12891-021-04336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Turner’s syndrome, discoid meniscus, and Blount’s disease have all been studied in isolation, but, to the best of our knowledge, there have been no studies reporting a patient with all three. Thus, the first case of Turner’s syndrome with discoid meniscus and Blount’s disease is presented. Case presentation A 5-year-old Japanese girl with a history of Turner’s syndrome and Blount’s disease complained of pain in her left knee. Magnetic resonance imaging showed a discoid lateral meniscus tear, and arthroscopic partial meniscectomy was performed, providing a good outcome. Conclusions In this report, some possible explanations regarding the concomitant presence of these three diseases are discussed. A possible explanation in this case is that the patient with Turner’s syndrome had a discoid lateral meniscus that might have been induced by some genetic factors associated with Turner’s syndrome, and then the discoid lateral meniscus might have been the mechanical stress that caused Blount’s disease.
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Affiliation(s)
- Tsunemasa Kita
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takuya Tajima
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Etsuo Chosa
- Department of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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25
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Assan BR, Simon AL, Adjadohoun S, Segbedji GGP, Souchet P, Metchioungbe CS, Fiogbe MA, Ilharreborde B, Gbenou AS. Guided growth vs.Tibial osteotomy at early stage of Blount disease in squelletically immature patients. J Orthop 2021; 25:140-144. [PMID: 35068774 DOI: 10.1016/j.jor.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There are no comparative study between guided growth and tibial osteotomy in early stage of Blount disease (BD) to our knowledge. The aim of this work was to compare the results of patients treated by these two techniques. METHOD This was a retrospective, descriptive, and analytical study over a period of 5 years in including 17 children (24 Knees) with an early stage of infantile BD in two centers. Patient were classified in two groups: group 1(treated by guided growth), group 2 (treated by Tibial Osteotomy).Preoperative alignment analysis using the tibial femoral angle (HKA) and the proximal medial tibial mechanical angle (mMPTA) were compared with three measurements taken postoperatively in each of the groups. The mean variations of the angles were compared between the two groups. RESULTS Socio-demographic characteristics were similar for the two groups. Median age at surgery was 6.5 ± 2.5 [3-9 years] in group 1 and 6.8 ± 2.9 years [3-9 years]. At a follow-up of 24 ± 3.5 months, the limb alignment was significantly corrected (1,03°/month) in group 1 (median HKA 144°-171°; p = 0,001; median MMPTA 78°-87°, p = 0,018), and in group 2 we observed at a follow-up of 23 ± 15 months a progressive loss (0,52°/month) of the correction obtained immediately postoperatively (median HKA 160°-176°(immediate post operative) to 165,5°; p = 0,31; median MMPTA = 78°-86° (immediate post operative) to 80,5°; p = 0,37).There was a statistically significant difference between the mean variation in HKA between the two groups (group 1 = 22,5; group 2 = 4,5, p = 0.00), as well as for MMPTA; (group 1 = 7; group 2 = 2,5, p = 0,023).The rate of correction was 78% in group 1 with no rebound at a median follow-up after removal of the material of 10 ± 2.4 months. Within group 2, the rate of correction was 10% with a recurrence rate of 60%. CONCLUSION Guided growth appears to be the best treatment for early stage of BD in squelletically immature patients.
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Affiliation(s)
| | - Anne-Laure Simon
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Sonia Adjadohoun
- Department of Medical Imaging, National Teaching Hospital Center Hubert Koutoukou MAGA, Cotonou, Benin
| | | | - Philippe Souchet
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
| | - Codjo Serge Metchioungbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Michel Armand Fiogbe
- Department of Pediatric Surgery, National Teaching Hospital Hubert Koutoukou MAGA, Cotonou, Benin
| | - Brice Ilharreborde
- Department of Pediatric Orthopedics, Robert Debre Hospital, Paris, France
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Blount's disease - an up-to-date insight with contemporary treatment guidelines deduced from critical analysis of a large 146 surgical case series. J Pediatr Orthop B 2021; 30:239-249. [PMID: 32694440 DOI: 10.1097/bpb.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To elucidate an up-to-date insight and derive clear treatment guidelines for Blount's disease deduced from critical analysis of 146 surgical case series. Cases were presented and analyzed separately under its two basic clinical groups and the author further derived four subcategories under each of these two groups; the first basic group was the early onset clinical variant; infantile tibia vara (ITV) included 56 cases. The second group was the late onset clinical variant; late onset tibia vara (LOTV) included 90 cases. Different operative procedures used for treatment of these cases were proximal tibial osteotomy (PTO), temporary eight-plate proximal lateral tibial hemiepiphyseodesis (PLTH), or medial plateau elevation either on a monomodal or multimodal line of treatment. After a mean follow-up period of ~5 (2-12) years, the results were critically analyzed using case series descriptive analysis. In ITV variant, both PTO and temporary eight-plate PLTH monomodal line of treatment gave satisfactory results for de-novo (stages I, II, and III) subcategory while multimodal line of treatment was needed for achieving satisfactory results for neglected (stages IV, V, and VI) and relapsed subcategories. For LOTV variant, PTO monomodal line of treatment gave satisfactory results when applied for treatment of its de-novo subcategory. The derived treatment guidelines for Blount's disease can be of value for recruiting the most suitable treatment modality for each case entity of the disease, leading to satisfactory outcome with prevention of recurrence.
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Gómez-Palomo JM, Meschian-Coretti S, Esteban-Castillo JL, García-Vera JJ, Montañez-Heredia E. Double Level Osteotomy Assisted by 3D Printing Technology in a Patient with Blount Disease: A Case Report. JBJS Case Connect 2021; 10:e0477. [PMID: 32649128 DOI: 10.2106/jbjs.cc.19.00477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe the case of a 26-year-old patient diagnosed with Blount disease. She underwent a medial oblique supracondylar biplanar closing-wedge osteotomy of the distal femur followed by a medial oblique biplanar opening-wedge osteotomy of the proximal tibia. 3D printed cutting guides were used for the procedures. At 18 months after surgery, the patient is pain-free and walks without aids. CONCLUSIONS Using 3D printed guides allowed for accurate correction of the deformity and reduced the risk of damaging critical structures. These guides could be an appropriate alternative for the surgical treatment of patients with Blount disease.
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Affiliation(s)
- Juan M Gómez-Palomo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Stephan Meschian-Coretti
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José L Esteban-Castillo
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan J García-Vera
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Elvira Montañez-Heredia
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Aly AS, Abdelhamid Alsabir AR, Fahmy HA, Fayyad TA. Modified oblique high tibial osteotomy with minimal fixation for correction of adolescent tibia vara: a prospective case series study. J Child Orthop 2021; 15:6-11. [PMID: 33643453 PMCID: PMC7907769 DOI: 10.1302/1863-2548.15.200097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To assess the reliability and efficacy of the modified oblique high tibial osteotomy for correction of complex deformity in adolescent tibia vara. METHODS A total of 19 patients (25 legs) with adolescent tibia vara were enrolled in this study. There were 16 male (84.2%) and three female (15.8%) patients who had modified Rab oblique osteotomy with minimal fixation performed. The age of the patients at time of surgery ranged from 12 years to 30 years (mean 17.23 (sd 5.27)). The body mass index ranged from 22 kg/m2 to 42 kg/m2 (mean 32.05 (sd 6.13)). All patients were followed up for over two years (mean 3.4; 2 to 5). RESULTS The femoro-tibial angle was improved from -34° to -12° (mean -20.04° (sd 5.24°) preoperatively and from -12° to 7°, postoperatively (mean 2.04° (sd 4.07)). Medial deviation of the mechanical axis corrected from 38 mm to 125 mm (mean 76.13 (sd 23.29)) preoperatively to 0 mm to 36 mm (mean 5.74 (sd 7.3)) postoperatively. The time needed to achieve union ranged from eight weeks to 16 weeks (mean 10.2 (sd 2.42)). According to the Lysholm functional knee score scale, there were 15 excellent (78.9%), two good (10.5%), one fair (5.2%) and one poor (5.2%) after correction of the deformity. CONCLUSION Modified Rab osteotomy with minimal fixation by two or three screws shows promising results with good correction of varus deformity (coronal plane), internal torsion (axial plane) and procurvatum (sagittal plane), in management of adolescent tibia vara with minimal morbidity and complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmad Saeed Aly
- Ain Shams University, Heliopolis, Cairo, Egypt,Correspondence should be sent to Ahmad Saeed Aly, Ain Shams University, 102 Marghany Street, Heliopolis, Cairo, Egypt. E-mail: ;
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Altowigri A, Mirghani HO. Blount Disease, Vitamin D deficiency, and Associated Comorbidities: A review and Meta-analysis. WORLD JOURNAL OF ENVIRONMENTAL BIOSCIENCES 2021; 10:5-8. [DOI: 10.51847/j96vx6dhpc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
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Abstract
BACKGROUND This study aimed to determine the recurrence rate in infantile Blount disease (IBD) in a cohort of patients treated with a tibial osteotomy; and also to identify which factors were associated with recurrence. METHODS We reviewed the records of 20 patients, under the age of 7 years, with IBD (35 involved extremities) treated by proximal tibial realignment osteotomy to physiological valgus at a single institution over 4 years. We then analyzed the data to determine the rate of recurrence and identify the risk factors for recurrence. RESULTS The mean age of the included patients was 4.2 years (range, 2 to 6 y). We observed a recurrence rate of 40% (n=14) at a mean follow-up of 42 months (range, 21 to 72 mo). Knee instability [odds ratios OR, 6.6; 95% confidence interval (CI), 2.0-22.2], Langenskiöld stage (OR, 6.3; 95% CI, 2.0-19.4), and severity of the deformity, as measured by medial physeal slope (MPS) (OR, 1.2; 95% CI, 1.1-1.4), were associated with recurrence. On multiple logistic regression analysis, MPS remained the most relevant predictor of recurrence. Receiver operating curve analysis showed that an MPS ≥60 degrees predicted recurrence with a sensitivity of 79% and specificity of 95% (area under the curve=0.925). Postoperatively, increased varus alignment on weight-bearing as measured by the tibio-femoral angle was indicative of knee instability and associated with increased odds of recurrence (OR, 1.5; 95% CI, 1.1-1.9; P=0.004). CONCLUSIONS We observed a recurrence rate of 40% in children with IBD under 7 years treated with acute correction to a tibio-femoral angle of 5 to 10 degrees valgus through a dome proximal tibial osteotomy. Knee instability, Langenskiöld stage, and MPS were associated with recurrence. Cases with an MPS ≥60 degrees seem to be particularly at risk for recurrence. Further research is needed to validate these findings. LEVEL OF EVIDENCE Level IV.
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Horn A, Boskovic V. Predictors of early recurrence following high tibial osteotomy for infantile tibia vara. INTERNATIONAL ORTHOPAEDICS 2020; 45:1233-1238. [PMID: 32936339 DOI: 10.1007/s00264-020-04808-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
AIMS Recurrence of deformity following high tibial osteotomy (HTO) for infantile tibia vara (ITV) is common. The purpose of this study was to identify risk factors for recurrent deformity following HTO for ITV and to develop a simple scoring system to quantify the risk of recurrence in each patient. PATIENTS AND METHODS We identified 69 patients with 102 affected limbs undergoing HTO for ITV from 2005 to 2015. Demographic and radiographic data was collected. On pre-operative radiographs, we measured the mechanical varus angle (MVA), the condyle shaft angle (CSA), the plateau depression angle (PDA), the metaphyseal-diaphyseal angle (MDA), and the mechanical lateral distal femoral angle (LDFA). On the post-operative radiographs, we measured the MVA and MDA only. We classified each limb according to the Langenskiold and LaMont classifications. Statistical analysis was performed to identify variables predictive of recurrent deformity, and these variables were analysed to develop a scoring system to quantify risk of recurrence following HTO. RESULTS Of the examined variables, age older than 4.5 years, an MVA of more than 23° and a LaMont type C deformity were predictive of recurrent deformity. The incidence of recurrent deformity increased from 14.3% with no risk factors to 91.3% with three risk factors present. CONCLUSION Advanced deformity and age above 4.5 years at the time of surgery predicts recurrent deformity following HTO for ITV. Surgery should be performed as soon as possible, and caregivers should be counselled appropriately regarding risk of recurrence and the need for future surgery.
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Affiliation(s)
- Anria Horn
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa. .,Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
| | - Viseslav Boskovic
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa
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Musikachart P, Eamsobhana P. Do Different Tibial Osteotomy Techniques Affect Sagittal Alignment in Children with Blount Disease? Orthop Surg 2020; 12:770-775. [PMID: 32301285 PMCID: PMC7307263 DOI: 10.1111/os.12674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 01/01/2023] Open
Abstract
Objective To determine the radiographic outcomes following dome or wedge‐shaped proximal tibial osteotomy in the management of infantile Blount disease with a particular interest in sagittal alignment of the knee joint. Method Medical records of patients with Langenskiöld stage 2 Blount disease (aged ≤5 years) who underwent surgical correction between January 2005 and November 2019 were retrospectively identified. Patients with metabolic bone disease, bone tumors, prior traumatic fractures, congenital anomalies, inadequate plain films, and incomplete medical documents were excluded. Patient characteristics (e.g. age, gender, and body mass index [BMI]) and surgical characteristics (e.g. side, type of surgery, and follow‐up times) were recorded. Antero–posterior (AP) and lateral knee radiographs were analyzed. Data were categorized by surgical technique as dome‐shaped proximal tibial osteotomy or wedge‐shaped proximal tibial osteotomy. The femorotibial angle (FTA) was used to evaluate the correction angle in varus deformities. Sagittal alignment of the lower limbs using the posterior tibial slope (PTS) angle was measured postoperatively at 3, 6, 12, and 24 months, and at the final follow‐up visit. Results The present study included 72 surgeries of 46 patients who had undergone proximal tibial osteotomy. Twenty‐nine (63%) were male. The mean age of patients at the time of surgery was 34.50 months (range, 26–47). The mean weight was 23.11 ± 4.98 kg (mean ± SD); the mean height was 95.33 ± 6.36 cm, and the mean BMI was 25.32 ± 4.36 kg/m2. The mean duration of follow up was 4.77 ± 2.78 years. Sixty‐four patients (88.90%) received dome‐shaped proximal osteotomy of the tibia, while 8 (11.10%) received wedge‐shaped proximal osteotomy of the tibia. The average FTA of the total correction measured was 29.32° ± 7.98°. The demographic data of the two groups were not significantly different for gender, age, BMI, side follow‐up times, and the total correction of varus deformities. In the dome‐shaped osteotomy group, the mean correction of the FTA was 29.59° ± 7.45°. The mean degree of the PTS angle was 6.50° at 3 months, 6.38° at 6 months, 5.32° at 12 months, 5.17° at 24 months, and 5.53° at the final follow‐up visit. In the wedge‐shaped proximal tibial osteotomy group, the mean correction of the FTA was 27.25° ± 11.77°. The PTS was 6.00° at 3 months, 7.50° at 6 months, 7.00° at 12 months, 5.40° at 24 months, and 5.57° at the final follow‐up visit. No significant difference was observed in the radiological outcome between surgical techniques. Conclusion Dome and wedge‐shaped proximal tibial osteotomies did not demonstrate significant differences in the PTS angle in children with Blount disease.
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Affiliation(s)
- Piyanuch Musikachart
- Department of Biochemistry,Siriraj Hospital, Mahidol University Bangkok Thailand
- Department of Orthopaedic SurgerySiriraj Hospital, Mahidol University Bangkok Thailand
| | - Perajit Eamsobhana
- Department of Biochemistry,Siriraj Hospital, Mahidol University Bangkok Thailand
- Department of Orthopaedic SurgerySiriraj Hospital, Mahidol University Bangkok Thailand
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Vasiliadis AV, Maris A, Gadikoppula S. Tibia vara or Blount's disease: Why an early diagnosis and treatment are important? Clin Pract 2020; 10:1222. [PMID: 32419907 PMCID: PMC7221452 DOI: 10.4081/cp.2020.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/06/2020] [Indexed: 01/05/2023] Open
Abstract
Tibia vara is an asymmetrical disorder of the proximal tibia that produces a threedimensional deformity, which was first described by Blount in 1937. A 6-year-old boy presented with a history of anterior knee pain with progressive bowing of his right leg over the last 1 year after having a fall while playing soccer. An early diagnosis and treatment of this disease can have a great functional impact and lead to very good health outcomes.
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Affiliation(s)
- Angelo V Vasiliadis
- 2nd Orthopaedic Department of Papageorgiou General Hospital, Thessaloniki, Greece.,School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Maris
- Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, UK
| | - Srinivas Gadikoppula
- Department of Trauma and Orthopaedics, North Middlesex University Hospital, London, UK
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Alsancak S, Guner S, Kınık H. Improved Gait Parameters After Orthotic Treatment in Children with Infantile Tibia Vara. Sci Rep 2020; 10:3187. [PMID: 32081856 PMCID: PMC7035344 DOI: 10.1038/s41598-020-59599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the modification of gait kinematics before and after orthotic treatment in patients with ITV. Vicon instrumented gait analysis was performed on three patients with ITV, pre and post treatment. Orthoses were applied a total of eighteen participants with ITV who were 25-38 months. 34 extremities were treated and radiographic evidence evaluated before and after orthotic treatment. Treatment duration for orthotic treatment ranged between 11 and 41 (25.9 ± 10.0) months. Only three patients were evaluated in gait analysis due to application difficulties. Three patients kinematic and kinetic instrumented gait analysis were found flatfoot, varus and internal rotation of the foot, hip flexion and external rotation. Study were reported an improvement in gait kinematics after orthotic treatment, in patients with ITV.
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Affiliation(s)
- Serap Alsancak
- Department of Prosthetics and Orthotics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Senem Guner
- Department of Prosthetics and Orthotics, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
| | - Hakan Kınık
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Griggs CL, Perez NP, Chan MC, Pratt JS. Slipped capital femoral epiphysis and Blount disease as indicators for early metabolic surgical intervention. Surg Obes Relat Dis 2019; 15:1836-1841. [DOI: 10.1016/j.soard.2019.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/09/2019] [Accepted: 06/20/2019] [Indexed: 02/08/2023]
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