An Orthopedic Surgeon’s Perspective On Child Obesity

An Orthopedic Surgeon’s Perspective On Child Obesity

by | Apr 17, 2019 | General News

Originally presented by Corey S. Gill, M.D., at the Sports Medicine for Young Athlete: How Do We Keep Our Kids Safe Conference in Frisco.
Childhood obesity is a significant public health problem and significantly increases the risk of developing a number of debilitating medical conditions, such as diabetes and heart disease. The prevalence of childhood obesity nationwide is approximately 15%, but is often much higher in pediatric orthopedic patients. For example, more than one third of my patients who require surgery for orthopedic problems are obese. Obesity may play a causative role in disorders such as slipped capital femoral epiphysis (SCFE) and Blount’s disease, and often increases the severity and complexity of fractures and other orthopedic injuries.

Conditions Often Found in This Population
SCFE is a condition that can develop in the hips of obese children and adolescents. The excess body weight increases the stress across the cartilage growth plate of the femur near the hip joint and can lead to a stress fracture or complete fracture. This condition always requires surgical intervention and may lead to significant long-term damage to the hip joint that necessitates additional surgery or even hip replacements at a young age. This condition is often difficult to diagnose, as the hip pain can be vague or even manifest as knee pain. All obese adolescents with significant hip/knee pain, or a noticeable limp, should be evaluated by a pediatric orthopedic surgeon.

Blount’s disease is another condition correlated with obesity. In this condition, there is severe bowing of the knees that leads to pain, joint damage and a significant visible deformity. Surgical treatment for mild Blount’s disease is called growth modulation. This treatment involves tethering a growth plate near the knee with a metal plate and screws, so that the leg can gradually straighten over approximately one to two years. In more severe cases, larger surgeries are often required to cut and realign the tibia bone, often with an external metal frame attached to the leg for stability.

Fractures or broken bones are relatively common in growing children. Obese children are more likely to sustain arm and leg fractures after a fall compared to normal weight peers. In addition, these fractures are usually more severe and more complicated to fix in obese children. Finally, the excessive soft tissue present in obese limbs makes fractures more difficult to hold in position in a cast. Consequently, many fractures that can be treated nonsurgically in normal weight children require surgical intervention in obese children.

Peri-operative Risks in Obese Children
Overweight and obese children often have medical comorbidities that increase risk of complications during and after surgery, such as anesthesia-related complications, infection and wound problems.  A thorough preoperative evaluation is recommended in obese patients undergoing surgery in order to optimize perioperative care. For example, sleep apnea is found in 85% of patients with Blount’s disease and hypertension is present in 65% of Blount’s and SCFE patients. Oftentimes, these medical comorbidities are undiagnosed at the time of presentation, so orthopedic surgeons play an important role in the recognition and diagnosis of these diseases.

Now What?
Childhood obesity is a difficult problem, and there are no easy solutions to eliminate the epidemic. A multidisciplinary approach with frequent communication between surgeons, pediatricians, nutritionists and other health care providers is mandatory to optimize orthopedic care of the obese patient. The pediatric and orthopedic communities must continue to support initiatives to encourage kids to be active and to eat a healthy balanced diet. Regarding diet, healthy eating habits need to be established at a young age, as studies have shown that obese children as young as 11 are already consuming in excess of 1100 to 1300 extra calories per day. Regarding activity, children and adolescents should be encouraged to participate in at least 60 minutes of physical activity each day. Participation in team sport, or other activities such as walking, running or biking, may decrease obesity rates and promote a lifelong love of a healthy activity.

Learn more about injury prevention and pediatric sports medicine.

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WFAA Honors Scottish Rite Hospital’s Don Cummings

WFAA Honors Scottish Rite Hospital’s Don Cummings

by | Apr 15, 2019 | General News, Press Coverage

On April 5, 2019, several Scottish Rite Hospital staff members gathered before the break of dawn at the WFAA studio for a “Party on the Plaza” to celebrate a segment that was aired live that morning. The hospital’s Director of Prosthetics Don Cummings had no idea the story was actually about him.

Don, who has been at the hospital since 1987, was honored as WFAA Daybreak’s Rise and Shiner — an honor given to those dedicated to changing lives for the better through their work. Don was nominated by his peers and former patients at Scottish Rite Hospital, and the staff that showed up early Friday morning truly showed their support for Don and his family.

Watch the full segment here.

Young Athletes and Soccer Safety: What You Need To Know

Young Athletes and Soccer Safety: What You Need To Know

by | Mar 8, 2019 | General News, Sports Medicine

Recently, sports medicine physician Shane M. Miller, M.D., joined a Facebook LIVE discussion with pediatrician Early B. Denison, M.D., from Pediatric Associates of Dallas. As an expert in caring for young athletes, Miller was interviewed to discuss soccer safety and injury prevention. Below is a recap of the discussion. Watch the live segment. What types of injuries occur in soccer?
  • Soccer is a contact sport, but has a large endurance component. Most acute injuries involve player to player contact that can result in ankle sprains, strains and/or contusions.
  • Other Injuries include mouth, face/nose, eye, oral/dental
  • Are there differences in injuries in youth players compared to high school players?
  • Increase injury rates go along with increased age.
  • The athletes are faster, stronger and more aggressive.
What about practice vs. games?
  • Many more injuries occur during games than practice.
  • Games bring a higher level of competition with a less controlled environment.
  • One study showed that about 2/3 of injuries occurred during the second half of the game.
Boys vs. girls?
  • Girls have a higher injury rate than boys.
  • Specifically, there are two significant injuries that we see more in girls that concern us: ACL injuries and concussions.
What to know about ACL injuries:
  • Very common in female athletes (non-contact), more than football, and about three times as many as boy soccer players.
  • The injury takes place typically when planting the foot to cut – the ligament stretches and tears.
  • It’s possible to hear/feel a pop and have swelling in knee.
  • It is a very serious injury with short and long-term implications for an athlete.
  • Usually eight to 12 months before returning to previous level of sport.
  • Possibility of a long-term arthritis risk and associated injuries such as meniscus tear, etc.
What about overuse injuries?
  • In younger soccer players (9-12), we see a lot of heel pain.
  • Growth plate overuse injuries are very common.
  • Adolescents complain mostly about knee pain (patellofemoral pain or Osgood-Schlatter’s). If there is swelling, limping, activity limitations, or symptoms more than a few days, the athlete should be evaluated by a pediatrician or sports medicine specialist.
How can we keep our young athletes safe? What recommendations do you have to reduce the risk of soccer injuries?
  • Follow/enforce the rules! Many injuries are preventable. Aggressive play increases risk of injury.
  • Proper equipment including shin guards.
  • Warm-up program – FIFA 11+ and 11+ kids both have been shown to reduce the risk of injuries by half, especially ACL tears.
  • Including a dynamic warm-up program should focus on balance, coordination, strength training and falling techniques.
What about concussions? What are your thoughts on headers?
  • Most injuries that occur around headers involve player-to-player contact – so heading is a high-risk play.
  • Additionally, younger players don’t have the coordination or neck strength to properly head the ball and absorb the forces.
  • US Youth Soccer has banned heading in players age 10 and younger.
Will soccer headgear prevent a concussion?
  • Headgear will not prevent a concussion and may increase the risk of injury by increasing athlete’s confidence/sense of invincibility. Following the rules, minimizing heading, increasing neck strengthening and not playing when fatigued/dehydrated are all very important in preventing a concussion.
What about reducing the risk of overuse injuries and burnout?
  • A pre-participation physical exam should be performed at least six weeks before the season with a primary care provider. This will allow injuries/issues to be noticed and addressed before the season begins.
  • Sport specialization – play multiple sports early on and specialize in late adolescence (i.e. high school).
  • Avoid year-round play – take a month off three times/year.
  • Hours/week shouldn’t exceed age in years.
  • Sports should be fun! Emphasize fun and all the benefits of sports, not winning and scholarships.
Learn more about the common injuries treated in our Center for Excellence in Sports Medicine.
Paving the Way to Bright Futures

Paving the Way to Bright Futures

by | Mar 1, 2019 | General News

If you are on the grounds of the hospital, take a moment to explore the James F. Chambers, Jr. Youth Fitness Park. The park features a large green lawn surrounded by an inviting walking path, which winds past decorative sculptures and recreational areas.

In this tranquil outdoor setting you will also find a brick pathway. Upon closer inspection, you will discover that these bricks are unique. Many of them are engraved with a name or personalized message to honor a loved one or celebrate a milestone.

But one thing these amber-colored blocks have in common is that each one is a symbol of hope and support for Scottish Rite Hospital patients.

“Participating in our brick program is a meaningful and affordable way for our donors to leave a legacy on the grounds of Scottish Rite Hospital,” says Stephanie Brigger, the hospital’s vice president of Development.

One of the longtime supporters, Dallas-area donor Michael Turner, began creating a legacy when the program started 20 years ago. Since then, he has donated more than 100 bricks to the hospital.

“I give from my heart,” Turner explains. “I give bricks rather than flowers because a brick will last forever.”

Individuals, families, corporations and anyone who wants to create a bright future for the patients of Scottish Rite Hospital can participate in the program. The cost of each brick is $150 and multiple bricks can be purchased, with all funds supporting the hospital.

Remember a loved one, commemorate a milestone or celebrate a special occasion, while benefiting hospital patients. To purchase a brick or receive more information, call 214-559-7618. You may also fill out an engraved brick donation form on our website here.

Scottish Rite Hospital Patients Depart For Annual Amputee Ski Trip

by | Feb 13, 2019 | General News, Press Coverage

Fourteen amputee patients from Scottish Rite Hospital received a grand send-off this week at DFW airport as they departed for the hospital’s annual Amputee Ski Trip. Representatives from Scottish Rite Hospital, American Airlines and DFW International Airport threw a party for the patients prior to their flight to Denver. The teenagers will spend a week at the National Sports Center for the Disabled (NCSD) in Winter Park, Colorado, where they will learn to ski and snowboard despite their limb differences.

Several patients discussed their excitement for the trip with local media, while representatives from the hospital offered insight on the benefits the trip provides to the kids. The goal of the trip is to foster a sense of self-confidence, discovery and independence for the patients. Snow skiing is well suited for amputees and, with special equipment, they can quickly become competitive and often excel at the sport.

Watch coverage of the send-off party from FOX 4 and CBS 11.

Dallas Mavericks Players Shoot Baskets With Scottish Rite Hospital Patients

by | Feb 12, 2019 | General News, Press Coverage

Dallas Mavericks players were joined by their mascot, Champ, last week as they visited patients at Texas Scottish Rite Hospital for Children. Three players from the Mavs shot baskets and played games with patients on the hospital’s multi-sport court. 

After an hour of shooting-around, the group headed inside to visit the hospital’s in-patient unit. Champ and the players passed out gift bags to each patient and posed for pictures with many of their families. The afternoon left a positive impact on both the patients and the players.

“It’s truly a blessing to get to spend some time with them, because they light up everybody that’s around them with their positive attitudes,” Dwight Powell, one of the Mavericks players on the visit, said.

Watch NBC 5’s coverage of the visit and see the Dallas Morning News’ photos from the day.