Vitamin D deficiency in slipped upper femoral epiphysis: time to physeal fusion

Abstract

Background: slipped upper femoral epiphysis (SUFE) has an incidence of 1-7 per 100,000 adolescents in the UK and its link with obesity well established. With a rising number of paediatric orthopaedic patients presenting with vitamin D deficiency, the aim of our study was to establish the prevalence of vitamin D deficiency in SUFE patients presenting to an orthopaedic department in the UK and whether a low vitamin D level increases the time to proximal femoral physeal fusion, post-surgical fixation.

Methods: a total of 27 paediatric patients, with a female to male ratio of 17:10 and a mean age of 11.5 years (SD 1.99), range 8 to 16 years, presented with a SUFE and had their vitamin D level assessed during the study period, June 2007 to July 2012 (inclusive). The majority of these patients (85.2%) were assessed as vitamin D deficient, with a serum 25-(OH)D <52 nmols/L . The time taken for >50% physeal fusion on anteroposterior radiography post-surgical fixation quoted in the literature is 9.6 months with no reported vitamin D deficiency or insufficiency.

Results: in our study the median time to physeal fusion in the vitamin D deficient and insufficient patients was 25 months, interquartile range 17-43 (mean of 29 months, SD 16.8). A negative correlation was also observed between vitamin D level and the time taken for physeal fusion following surgical fixation.

Conclusion: we conclude that a high prevalence of vitamin D deficiency has been observed in our SUFE patients. Comparing the time taken for physeal closure as 9.6 months in the literature with vitamin D deficient patients, this is prolonged. Indeed a negative correlation between vitamin D level and time to physeal fusion has been demonstrated. This study highlights the need for regular vitamin D status assessment in SUFE patients in order to allow early implementation of treatment with vitamin D supplementation. The impact of vitamin D screening and supplementation on SUFE outcomes should be investigated further.

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ORCID for Isabel Reading: orcid.org/0000-0002-1457-6532

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