Slipped upper femoral epiphysis: Outcome after in situ fixation and capital realignment technique.

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?