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LETTER TO EDITOR  
Year : 2014  |  Volume : 48  |  Issue : 1  |  Page : 111
Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique


1 Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication21-Jan-2014
 

How to cite this article:
Tripathy SK, Sen RK. Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique. Indian J Orthop 2014;48:111

How to cite this URL:
Tripathy SK, Sen RK. Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique. Indian J Orthop [serial online] 2014 [cited 2019 Sep 23];48:111. Available from: http://www.ijoonline.com/text.asp?2014/48/1/111/125538
Sir,

We read the article "slipped upper femoral epiphysis (SUFE): outcome after in situ fixation and capital realignment technique" with interest. [1] This study is first of its kind where the outcome of SUFE has been evaluated in Indian children. The authors also found the association of high body mass index, vitamin D deficiency and endocrine disorders in SUFE children. However, we have few concerns about the results of the study.

The authors found mean vitamin D level to be 12.61 ± 5.4 ng/ml with a range from 3.76 to 25.6 ng/ml. There were 20 out of 21 children who were severely vitamin D deficient, but no rachitic changes were evident. As per recent recommendations, in children and adolescents, vitamin D level above 20 ng/ml is considered as sufficient, 15-20 ng/ml as insufficiency, <15 ng/ml as deficient and <5 ng/ml as severely deficient. [2] With the mean value of 12.61 and standard deviation of 5.4, how could it be possible that 20 out of 21 children were severely vitamin D deficient? Vitamin D deficiency is widespread in India in all age groups. In one study, the mean serum concentration of 25(OH) D among North Indian children was found to be 11.8 ± 7.2 ng/ml (below the average value of the present study). [3] The study by Marwaha et al. [4] has shown that adolescents in Delhi from upper and lower socioeconomic groups had mean serum 25(OH) D concentration of 31 nmol/L (equivalent to 12.4 ng/ml). They also found that despite supplementation with 60,000 IU of vitamin D3 (monthly 2000 IU/day or 2 monthly 1000 IU/day), only 47% subjects were vitamin D sufficient at the end of 1 year (mean 25[OH] D level 50.1 nmol/L). We feel that measurement of vitamin D level in healthy children or adolescent (control group) would have better clarified the association of vitamin D deficiency in SUFE. With wide prevalence of vitamin D deficiency in India even in healthy children, is this association of vitamin D deficiency and SUFE a new conception?

 
   References Top

1.Arora S, Dutt V, Palocaren T, Madhuri V. Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique. Indian J Orthop 2013;47:264-71.  Back to cited text no. 1
  Medknow Journal  
2.Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M, Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: Review of current knowledge and recommendations. Pediatrics 2008;122:398-417.  Back to cited text no. 2
    
3.Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, Sawhney RC, et al. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. Am J Clin Nutr 2005;82:477-82.  Back to cited text no. 3
[PUBMED]    
4.Marwaha RK, Tandon N, Agarwal N, Puri S, Agarwal R, Singh S, et al. Impact of two regimens of vitamin D supplementation on calcium-Vitamin D-PTH axis of schoolgirls of Delhi. Indian Pediatr 2010;47:761-9.  Back to cited text no. 4
[PUBMED]    

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Correspondence Address:
Sujit Kumar Tripathy
Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.125538

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1 Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique: Authoręs reply
Arora, S., Dutt, V., Palocaren, T., Madhuri, V.
Indian Journal of Orthopaedics. 2014; 48(1): 111-112
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