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More Research Needed into Correction of Angular Deformities in Children

Posted on: 11/25/2009
Lower extremity (leg) angular deformities are commonly seen by pediatric orthopedic surgeons, bone surgeons. They can be coronal, the invisible division from front to back, sagittal, dividing left from right, or transverse, dividing top from bottom. While some deformities don't change, others are progressive, they get worse with time. The progressive deformities can have an impact on how the child walks (his gait), cause pain, and possibly cause other problems down the road, such as arthritis.

Deformities of the leg can be congenital, meaning the child was born with it, idiopathic, no reason why the deformity occurred, or acquired, it happened after birth. The causes include certain health issues that affect the minerals in the body that strengthen bone, skeletal problems, traumas, or infections, to name a few. For example, one disease, Blount's disease is a common cause for both young children and adolescents. In Blount's disease, the inner part of the shin, just below the knee, doesn't develop as it should and this results in bowed legs.

When a doctor is looking at an angular deformity, he or she must take a thorough medical history and perform a physical evaluation. The history includes information such as when (if) the child began walking, any family history of such problems, the child's birth, nutritional status, any infections or previous bone breaks, and so on. The doctor should watch the child walk to look for any signs. Certain signs, such as the Trendelenburg sign can suggest a problem with the hip and the leg, for example.

Standard testing includes x-rays, usually a standing x-ray. When a child is lying down to have an x-ray of the leg, the leg isn't being stressed as it is when the child is standing. Therefore, a standing x-ray would be more reliable. Blood tests may be done if the doctor suspects a nutritional problem or an issue with minerals or hormones. However, these are not routine tests.

Treating the deformities is as individual as the causes and the diagnosis. Options range from bracing (non-surgical treatment) all the way to surgery. And, even if a particular deformity is often treated surgically, it isn't always. For instance, Blount's disease can be treated surgically, but only if the angle of the deformity has reached a certain height. Under that, bracing is the first choice treatment. Ring fixators are another treatment option. These are wires and rods that are surgically inserted into the bone and come out through the skin. They are then attached to a frame and this stabilizes the bone. While this treatment has advantages, there are risks involved - the most common one being infection where the rod enters/exits the skin.

The authors of this article concluded that there still is much research to be done in this area. The use of computers to help find the best angle for correction is one step and this can be compared with more traditional treatment to see which is best and in which circumstances.

References:
Paul C. Celestre and Richard E. Bowen. Correction of angular deformities in children. In Current Orthopaedic Practice. Nov./Dec. 2009. Vol. 20. No. 6. Pp. 641 to 647.

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