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Incidence of obesity and clinical characteristics of adolescents with slipped capital femoral epiphysis: Can a BMI in the 95th percentile for age predict bilateral involvement?

1 August 2002

Abstract

Background: Childhood obesity continues to be an ever-increasing health concern with the latest statistics of overweight kids ages 6-11 doubling in the past two decades and tripling among teens." Slipped capital femoral epiphysis (SCFE) has been associated with overweight stature in the adolescent population along with numerous other health-related problems. The purpose of this study was to identify a significant relationship between obesity (those with an increased BMI in the 95th percentile) and the occurrence of bilateral slipped capital femoral epiphyses. A comparative analysis to look for differences in previously reported findings was also performed.

Methods: A retrospective chart review was conducted of patients treated by a Pediatric Orthopedic Surgeon for a 10-year period. The data was collected from both the physician's clinic and the hospital medical records department with the use of flow sheets and entered into a computer spreadsheet by one analyst. Data included patient demographics, height, weight, type and classification of fracture, reported symptoms, duration of pain, complications, and length of follow-up . Body mass index (BMI) was calculated using Archimedes software program. BMI was then recorded as a percentile referencing the National Center for Health Statistics and Center for Disease Control (CDC). In addition, a chi square test and correlation models were implemented with SPSS statistical software program.

Results: 53 patients with 67 slipped capital femoral epiphyses were examined. Bilateral involvement was reported in 28% and among those, 60% of patients recorded a BMI in the 95th percentile or considered obese. 62% of the total SCFE patient population was in the 85th percentile for DMI or otherwise overweight. 56% of cases reported had a SCFE involving the left side versus 43% occurring on the right. Pearson's chi square test was conducted for the data and showed significance (p=.034) with regard to SCFE type (unilateral vs. bilateral) and BMI percentile rank (includes all percentiles) in a cross-tabulation. However, logistic regression showed a weak correlation and no significance. Both the Pearson and Spearman correlation showed no significant relationship between the variables with regard to the 95th percentile and bilateral SCFEs. Male predominance occurred in 69% compared to 30% for females. Grade I and II (mild to moderate) type severity o/slips were recorded in 43% and 37% of cases respectively. Those with atypical characteristics or involving endocrine or renal disorders accounted for only 5.5% of the cases. Nonwhites accounted for only 20% of the patient population. 80% of the patients were ages 10 to 13 years old with the median age being 13. The mean age was 12.17 years.

Conclusion: Although the chi square test showed significance with regard to all BMI percentiles, the ability to predict bilateral SCFEs in patients with a specific BMI among the 95th percentile was not possible in our study given the data available. Therefore the null hypothesis was correct and no relationship between bilateral SCFEs and the 95th percentile for BMI was found. Multiple regression may have been more definitive if the N value (population size) had been much larger.


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