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Idiopathic Slipped Capital Femoral Epiphysis in Amish Children
Randall T. Loder, MD1; Jeffrey Nechleba, MD2; James O. Sanders, MD2; Patricia Doyle, RN3
1 James Whitcomb Riley Hospital for Children, Room 4250, 702 Barnhill Drive, Indianapolis, IN 46202. E-mail address: rloder@iupui.edu
2 Erie Shriners Hospital for Children, 1645 West 8th Street, Erie, PA 16505
3 Twin Cities Shriners Hospital for Children, 2025 East River Parkway, Minneapolis, MN 55414
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Twin Cities Shriners Hospital for Children, Minneapolis, Minnesota, and the Erie Shriners Hospital for Children, Erie, Pennsylvania

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(3):543-549. doi: 10.2106/JBJS.D.01773
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Background: Of the many studies of slipped capital femoral epiphysis, none have specifically addressed Amish children. The Amish reflect a small gene pool relative to the general white North American population. Additional knowledge of the demographics of this disorder in Amish children may provide genetic insights. The purpose of this study was to review the demographics of slipped capital femoral epiphysis in the Amish population.

Methods: A retrospective review of the cases of twenty-five Amish children with slipped capital femoral epiphysis treated at two institutions was performed. The child's gender, age, weight, height, and body mass index at the time of the diagnosis; duration of symptoms; laterality of the slip; birth weight; family history; and slip severity were recorded. The slip was classified as stable or unstable. Patients who had been included in a previously published multicenter study served as a control group.

Results: There were seventeen boys and eight girls with a total of thirty-three slipped capital femoral epiphyses; eight of the slips were bilateral. At the time of the diagnosis, the mean age (and standard deviation) was 13.4 ± 1.6 years, the mean weight and height were 55.6 ± 12.4 kg and 155.5 ± 10.2 cm, and the mean body mass index was 23.4 ± 5.4 kg/m2. The mean duration of symptoms was 6.6 ± 9.0 months. There were thirty-one stable and two unstable slips with a mean slip angle of 38° ± 20°. Nine (39%) of twenty-three children for whom the information had been recorded had a positive family history of slipped capital femoral epiphysis, a rate that is higher than the 9% and 14.5% rates reported in two other series (p = 0.002). The Amish children were not as heavy as their non-Amish counterparts (55.6 ± 12.4 kg compared with 66.4 ± 17.7 kg, p = 0.0036).

Conclusions: Although the children in this study were moderately heavy, they could not be classified as obese on the basis of weight-for-age or body-mass-index percentiles. The high prevalence of family members with slipped capital femoral epiphysis may reflect either a genetic or environmental component, or an interaction between genetics and environment (for example, work load or common chores requiring particular physical positions) in the Amish population.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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