Browsing by Subject "slipped capital femoral epiphysis"

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    Seasonal Variation in Slipped Capital Femoral Epiphysis: New Findings Using a National Children’s Hospital Database
    (Wolters Kluwer, 2019-01) Loder, Randall T.; Schneble, Chris A.; Orthopaedic Surgery, School of Medicine
    Background: Slipped capital femoral epiphysis (SCFE) demonstrates seasonal variation in certain latitudes but not others. Is such variation influenced by temperature differences, sunlight exposure and subsequent vitamin D production, or other climate variables? It was the purpose of this study to further investigate the seasonal variation in month of presentation for SCFE. Methods: Data for this study originated from the Pediatric Hospital Information System for all children with a diagnosis of SCFE from January 1, 2004 through December 31, 2014. From this database the patient’s sex, ethnicity, hospital location, and month of presentation was determined. Only those patients treated primarily for SCFE were included. Geographic and climate data [latitude, average annual temperature, precipitation, climate type (Köppen-Geiger and Liss), horticultural plant zone hardiness, and sunlight exposure] for each of the 49 Pediatric Hospital Information System hospitals was determined. Seasonal variation was analyzed using cosinor analysis. A P<0.05 was considered statistically significant. Results: There were 10,350 cases of SCFE with an overall peak presentation in mid August. For those living at a latitude of >35-degree N there was single peak, a less prominent double peak for those 31- to 35-degree N, and no variation for those <31-degree N. As the average annual temperature increased there was less seasonal variability. Humid, temperate and cold winter climates demonstrated seasonal variation, whereas other climate types did not. Those living in areas having <2500 hours of sunlight per year demonstrated seasonal variation. Further, areas having a photovoltaic solar production potential <5.0 kWh/m2/d also demonstrated seasonal variation. Conclusions: We discovered new seasonal variation findings regarding SCFE. These are a double peak pattern for those between 31- and 35-degree N latitude; less variability as the average annual temperature increases; and sunlight exposure correlates with seasonal variability. Potential explanations are a rachitic state due to seasonal variation in vitamin D production, and seasonal variation in physeal growth and strength. These new findings will require further investigation.
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    Slipped capital femoral epiphysis: a spectrum of surgical care and changes over time
    (Bone & Joint Publishing, 2017-04) Loder, Randall T.; Orthopaedic Surgery, School of Medicine
    Purpose To survey the spectrum of surgical care in children with slipped capital femoral epiphysis (SCFE). This information is valuable in counselling the patient about the future treatment course. Methods Data for this study were obtained from the Pediatric Hospital Information System (PHIS) between 2004 and 2015. For all patients with an ICD9 diagnosis of 732.2, gender, ethnicity, hospital, medical record number, date of birth/admission/discharge, type of admission, length of stay, disposition and treatment(s) rendered were collected. Results A total of 13 168 procedures were performed in 11 058 unique SCFE patients, or 1.2 procedures per patient. Primary procedures were those performed for the initial treatment of the SCFE and secondary procedures as reconstructive and salvage. The majority (11 693, 88.8%) were primary. There was significant variation in the ratio of primary and secondary procedures by institution. There was a decline in in situ fixation as the initial SCFE treatment with an increase in open reduction and internal fixation over the 12-year span. Similarly, there was a significant increase in the number of secondary procedures over time as well as complications and implant removal. There was no change over time in the diagnosis of avascular necrosis. Conclusions The average number of surgical procedures in patients was in the range of 1 to 6 and varied widely by hospital. Each physician should know his/her own hospital’s data for the percentage of subsequent procedures so as to counsel the patient and family properly. The increasing number of complications over time may reflect the increasing number of more complex procedures.