HJAR Sep/Oct 2022

44 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF ARKANSAS CHILDREN’S HEALTH COLUMN CHILDREN’S HEALTH possible, this is often preferred by moth- ers. 4, 5 Prenatal diagnosis has several po- tential benefits, including the option of prenatal counseling, post-partum care coordination, and the ability of the family to make preparations at home. This can be especially helpful to optimize multi-sys- tem screening studies as needed. After birth, the diagnosis and prognosis are confirmed, and a general treatment strate- gy is developed with the family. Treatment options for this group of pa- tients are highly variable and can include observation alone, orthoses or prostheses, and surgical procedures such as growth modulation, limb lengthening, or ampu- tation. These patients often benefit from a multidisciplinary team approach to opti- mize each episode of care. The overweight adolescent with a bowleg On the other end of the spectrum is the more commonly encountered ado- lescent with obesity and bowlegs. Obesity currently has an estimated prevalence of 36.4% in adults and 22.1% in adolescents statewide. 6 This has several implications for bone and joint health, but there is an Pediatric Limb Deformity: Consider Comorbidities Before Surgery Introduction Pediatric limb deformities are common in general practice. Everyone has seen a child with bowlegs, knock knees, or a dif- ference in leg lengths. Many of these chil- dren will require nothing more than reas- surance, but some deformities may herald a more significant underlying medical problem that requires attention. It is im- portant to identify these patients, so they can have appropriate workup, counseling, and treatment to improve their long-term function and quality of life. Lower extremity growth: lots can go wrong Alterations in skeletal growth can oc- cur from a variety of etiologies, including trauma, infection, inflammatory arthritis, radiation, genetic syndromes, or congeni- tal malformations. Although children with a growth arrest after a fracture or infection are often otherwise healthy, practitioners and families should be aware that congen- ital limb malformations and developmen- tal deformities such as adolescent tibia vara (Blount’s disease) can sometimes be the most obvious presentation of more systemic pathology. The infant with a limb malformation: early diagnosis helps optimize patient care Limb malformations — congenital con- ditions in which an anatomical structure is abnormally formed or completely ab- sent — are rare, occurring in only 2.1 to 5.6/10,000 births. 1 Because of their rela- tive rarity, many practitioners have limit- ed experience with this population, which includes patients with proximal focal femoral deficiency and tibial and fibular hemimelia. An estimated 50% of patients with significant congenital limb malfor- mations have other major anomalies in- volving the skeleton, internal organs, or nervous system. 2 In particular, there is a 12% and 15% risk of cardiopulmonary and urogenital anomalies, respectively, in this group. 2 Those at especially high risk of other organ involvement are patients with bilateral limb malformations, tibial or ra- dial-sided deficiencies, and features sug- gestive of a syndrome such as VACTERL. 3 In these patients, screening studies may be warranted. In many cases, major limb malforma- tions are identifiable during first trimes- ter prenatal ultrasound screening — when