Reslip of a Previously Fixed Slipped Upper Femoral Epiphysis with an Associated Vitamin D Deficiency

Slipped upper femoral epiphysis (SUFE) is a relatively common adolescent hip disorder that represents a biomechanical instability of the proximal femoral growth plate. A link between vitamin D deficiency and SUFE has emerged in recent years; however, we present a unique case of a 10-year-old girl who presented with a reslip of a previously fixed SUFE with an associated vitamin D deficiency. 1. Introduction Slipped upper femoral epiphysis (SUFE) is a common adolescent hip disorder that represents a biomechanical instability of the proximal femoral growth plate. This usually leads to a posteroinferior slip of the epiphysis. It usually presents with hip pain, progressing to a limp and sometimes a leg length discrepancy. If not detected and treated it can lead to avascular necrosis, degenerative hip disease, and gait abnormalities. The overall incidence of SUFE in the United States is 10.8 per 100,000 children and is three times more common in boys than girls [1, 2]. The exact pathology of this condition is still unknown; however, the typical presentation is of an obese adolescent. SUFE has been associated with endocrine abnormalities such as hypothyroidism, hypogonadism, and growth hormone deficiency [3, 4]. Vitamin D deficiency is a common nutritional deficiency in children and has been associated with bone growth as well as bone mineral density of adolescent children [5]. There has only been one case report in the US that has suggested a link between vitamin D deficiency and SUFE [6]. This paper presents a case of a 10-year-old girl who presented with a reslip of a previously fixed SUFE and a vitamin D deficiency. 2. Case Report In 2010, a 10-year-old girl presented with left thigh pain. Radiographs revealed evidence of significant slippage of the left upper femoral epiphysis and a possible early slip on the right. She had no significant past medical history and was not obese. The patient underwent bilateral single screw fixation. The result was satisfactory with no operative complications. She made good progress following this with a pain-free period for almost 2 years. She was followed up twice yearly and radiographs were unremarkable. In 2012 she came to clinic complaining of increasing pain in the right groin. She was walking with a Trendelenburg gait and on examination she had an irritable hip with fixed external rotation and impingement sign positive on the right side. The initial slip in the left side had fused fully on repeat radiographs. However, on the right side the upper femoral epiphysis had reslipped despite being fixed with a cannulated