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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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Infant and Developmental Dysplasia of the Hip

Infant and Developmental Dysplasia of the Hip

by | Mar 20, 2019 | Hip Disorders

In its highly regarded medical journal, Pediatrics, the American Academy of Pediatricians (AAP) just published a review of current standards for evaluating and treating a condition often recognized in newborns and infants. The condition is called developmental dysplasia of the hip (DDH). Dysplasia is a term that means poorly formed. It describes this condition well because one or both sides of the hip joint do not grow correctly as the child develops.

With later recognition of the condition, the treatment becomes more complex and may even require complex surgery. In order to minimize missed cases of hip dysplasia, the AAP recommends that pediatricians periodically screen for DDH during routine office visits from infancy until the child is walking.1 With effective screening, most cases are identified and managed during infancy, leading to complete correction of hip dysplasia and the development of normal hips.

Though this condition rarely requires surgery, Scottish Rite Hospital has a team of pediatric orthopedic surgeons focused on conditions affecting the hip. Corey S. Gill, M.D., M.A., sees these and other patients in his clinic in Frisco. Here are the top four things parents of newborns need to know and do:

  1. Know that DDH occurs in approximately 1% of children. Though the occurrence is low, early identification of these cases is important.
  2. Ask for an evaluation if your baby has one of the two strongest risk factors for DDH.
    • Delivered feet first (breech position)
    • Related to someone who has been treated or monitored for DDH
  3. If your infant is diagnosed with DDH, there is a greater than 90% chance of correcting the condition without needing surgery.  
  4. Learn how to properly swaddle. Many videos online teach “how to swaddle” your baby. Watch one of our hip experts demonstrate how to properly swaddle a baby and learn more about how swaddling can increase the risk of DDH.

When infants need treatment for hip dysplasia, our first line of defense is a Pavlik harness. The harness is generally worn for 23 hours per day for approximately six weeks, but it is removable for bathing. The harness keeps the legs flexed and rotated in the right position for normal development of the hip joint.  After treatment with a Pavlik harness, we use physical exams, ultrasound and X-rays to monitor growth and confirm the hip joint is developing properly.  Most children require no further orthopedic treatment after wearing a Pavlik harness.

Learn more about our treatment and research in DDH and other conditions affecting newborns.

1Yang S, Zusman N, Lieberman E, et al. Developmental Dysplasia of the Hip. Pediatrics. 2019;143(1):e20181147
Health Care Providers Gather in Frisco to Learn from Hospital Experts

Health Care Providers Gather in Frisco to Learn from Hospital Experts

by | Mar 5, 2019 | Sports Medicine

Over the weekend, Scottish Rite Hospital hosted the Pediatric Orthopedics and Sports Medicine Symposium (POSMS) at the Frisco campus. In its first year, POSMS is a combination of two medical conferences – Pediatric Orthopedics Education Series and the Sports Medicine for the Young Athlete. The one-day meeting welcomed over 110 health care specialists from around the community including pediatricians, advance practice providers, athletic trainers, physical therapists and other medical professionals. Attendees learned the latest in evaluation and treatment of pediatric orthopedic and sports medicine conditions through lectures and hands-on breakout sessions.

Several of the hospital’s staff presented throughout the day. Topics included:

  • Developmental dysplasia of the hip
  • Acute knee injuries in young athletes
  • Hip conditions in young athletes
  • Myths of sports-related concussions
  • Rheumatology
  • Scoliosis screening
  • Hot topics in sports medicine treatments
  • Return to play and testing in the movement science lab
  • Ethical implications in fracture management
  • Safety of popular diet and supplement trends

Here is some of the positive feedback we have received so far:
Every talk was helpful and high-yield. This was all great!
Thank you for such a great conference. Loved the variety of topics and knowledgeable speakers.
The fracture splinting small group was fantastic.
Location is great. Building is beautiful.
All of the speakers were great and engaging.
It was super helpful to have kids demonstrate the exams!
Enjoyed every lecture; very informative and all relevant to my practice.

Course director and sports medicine physician, Shane M. Miller, M.D., said, “We really enjoy the opportunity to connect with the community providers at these events. We genuinely want to support everyone who provides care to children and adolescents. Together, we are better.” 

Learn more about the Center for Excellence in Sports Medicine. 

Corey S. Gill, M.D., M.A., joins Texas Scottish Rite Hospital for Children Surgical Team

Corey S. Gill, M.D., M.A., joins Texas Scottish Rite Hospital for Children Surgical Team

by | Jan 12, 2018 | General News, Press Coverage

(DALLAS – January 11, 2017) – Corey S. Gill, M.D., M.A., has joined the pediatric orthopedic surgical staff of Texas Scottish Rite Hospital for Children. Gill will lead the team for general orthopedics at the new Scottish Rite for Children Orthopedic and Sports Medicine Center opening in Frisco this fall. Until the new center opens, he will primarily see patients at the interim facility located in Plano. 
Gill comes to Scottish Rite Hospital from private practice at Southwest Pediatric Orthopedics here in Dallas. In addition to his role at Southwest Pediatric Orthopedics, Gill also served as the Medical Director of Pediatric Orthopedics at Medical City Dallas. During his time as director, he helped guide Medical City’s transition from a Level III to Level II Trauma Center for pediatric orthopedics. 

“Dr. Gill first came to Scottish Rite Hospital for his fellowship in 2012,” says Daniel J. Sucato, M.D., M.S., Scottish Rite Hospital Chief of Staff. “Seeing his skills flourish during his fellowship, and in his post-fellowship practice here in Dallas, has been an honor. It’s exciting to welcome him back as he returns to join our orthopedic surgical staff.

TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN. A man wearing a white coat with texas scottish rite hospital on it

Before completing Scottish Rite Hospital’s Dorothy & Bryant Edwards Fellowship in Orthopedics and Scoliosis in 2013, Gill attended medical school at Washington University in St. Louis where he earned both his doctor of medicine and master’s degree. He completed his orthopedic surgical residency at the Washington University in St. Louis’ Department of Orthopedics. 

“It’s an exciting time to be at Scottish Rite Hospital,” says Gill. “The world of medicine and health care is ever changing and Scottish Rite Hospital is positioned to remain at the forefront of both patient care and education.  The hospital provided me with a world-class fellowship training experience and I’m thrilled to be returning to the staff in a more permanent capacity.”

“Our highest priority at Scottish Rite Hospital is to provide world-class care to our patients,” says Robert L. Walker, Scottish Rite Hospital president/CEO. “Dr. Gill’s expertise and leadership experience will ensure our patients continue to receive the highest level of care possible. As our organization continues to expand, we are extremely pleased to have him join our staff during this significant period of growth.” 

Gill is actively involved in both the medical and local Dallas community. In addition to his role at Scottish Rite Hospital, he will also serve as an assistant professor in UT Southwestern’s Department of Orthopaedic Surgery. He is a member of the American Academy of Orthopedic Surgeons, the Pediatric Orthopaedic Society of North America and the Texas Medical Association. 

Read D CEO Healthcare’s article here.