DEFINITION ORTHOPEDIC

Two orthopedic conditions are of particular importance in pediatric obesity — Blount disease and
slipped capital femoral epiphysis. Both occur primarily in younger adolescents and preteens, and
both are disorders of the lower extremity. Both conditions may lead to a vicious cycle of overweight
making the orthopedic condition worse, while the raised barrier to physical activity that theconditions present then make the overweight condition worse, and so on. Both should be considered
orthopedic emergencies requiring surgical consultation because they can be crippling.
Blount disease (also known as Tibia vera, or Genu varum) presents as a bowing of the leg with
or without pain and limp. It consists of an abnormality in the growth of the medial portion of the
proximal tibia. It is unclear whether this abnormality is caused by excess weight placed on the
joint at a critical stage in development or whether it is an underlying condition that is aggravated
by the excess weight. Plain anterior–posterior x-rays of the leg characteristically show irregularity
of the growth of the proximal medial tibial physis, with beaking or a triangulation of the metaphysis.
Surgical correction is by osteotomy.
Slipped capital femoral epiphysis occurs when the epiphysis of the proximal femur slips off
the metaphysis posteriorly and medially secondary to increased weight on the cartilaginous growth
plate of the hip [39]. The classic patient is an overweight, hypogonadal boy with delayed bone age.
Symptoms include limp, hip or knee pain, and the typical antalgic gate, with the leg externally
rotated and abducted.