Prophylactic pinning of the contralateral hip remains controversial in the management of unilateral SUFE. This paper reviews our experience, with particular reference to the fate of the non-operated hip.

We reviewed the charts and radiographs of 218 patients who were admitted to Starship Children’s Hospital between 1988 and 2000 with a diagnosis of SUFE. Of the 211 patients with data sufficient for analysis, 168 (80%) had unilateral hip pinning and 43 (20%) had bilateral pinning. 32.8% of patients with a unilateral slip were subsequently readmitted for pinning of the contralateral hip. The time between the two operations averaged 7.5 months and did not vary with race or gender. European females had an almost 50% readmission rate for pinning of the opposite hip while Maori females had the lowest readmission rate (15%). All European females less than 11.5 years with unilateral slips returned for pinning of the opposite hip. 28 of the initial unilateral hip pinnings were for an unstable SUFE. Only 8 of the 28 patients were readmitted for pinning of the opposite hip, all with stable slips. Only one patient with a stable first slip presented with an unstable second slip.

Despite a high incidence of bilateralism, this study shows that it is very uncommon for a patient to present with an unstable second slip. Prophylactic pinning can have complications. We therefore recommend follow-up rather than prophylactic pinning for patients presenting with unilateral SUFE. Caucasian females less than 11.5 years represent a group at high risk of a second slip.

To determine whether elderly patients presenting with a fracture of the proximal femur have an underlying vitamin D deficiency.

We identified 59 consecutive cases of a fracture of the proximal femur over a 10-week period. 16 patients were excluded as they had a secondary underlying cause of bone loss which included chronic renal disease, rheumatoid arthritis, thyroid/parathyroid disorders, long term steroid usage and malignancy.

Of the 43 that were eligible for the study, 7 were men and the average age was 81 years. 9 had sustained previous osteoporotic fractures. The majority mobilised independently or with 1 stick prior to the fall and the mechanism in all cases was a low velocity injury from standing height or less.

The mean vitamin D3 level in these cases was 28. 3 nmol/ l. 28 of the 43 had a pathologically low level of vitamin D3 as defined as < 30nmol/l.

The mean PTH level was 53. 7 nmol/ l. 15 of the 43 had an elevated PTH and all 15 were also deficient in vitamin D.

The mean Albumin, an indicator of nutritional status, was 29 g/l.

This study highlights that 65% of the patients who present with a fracture of the proximal femur are depleted in vitamin D. The ageing process is associated with a reduction in the intake of vitamin D, gut absorption and its sunlight activation. Repletion of vitamin D and suppression of parathyroid hormone, both prophylactically or at the time of injury, may reduce future fracture risk and assist in fracture repair.