Aim. In an earlier study we identified severe Vitamin D deficiency as a problem in institutionalised children with cerebral palsy (CP), which resulted in rickets and a high incidence of fractures. The purpose of this study was to establish whether a cohort of non-ambulatory children with CP, living at home, presented with Vitamin D deficiency. Method. The participants were a consecutive sample (N=100) of non-ambulatory children with CP attending a CP outpatient clinic. Their ages ranged from 2 to 15 years (mean 5.8, SD 3.3 years). There were 57 males and 43 females. Nineteen were on Level IV of the Gross Motor Function Classification System (GMFCS), and 81 were on Level V. 66% were on anticonvulsant therapy (ACT). Basic demographic data was collected, and measurements included blood sample analysis and wrist radiographs. There was radiographic evidence of osteopenia and delayed ossification of the carpal bones. Results. Three participants had Vitamin D deficiency rickets confirmed by wrist changes and serology. There was a significantly higher level of Alkaline Phosphatase (p=0.04) in children on ACT than in those who did not receive ACT. Preliminary results show that one third of the children had Vitamin D deficiency. Conclusion. Non ambulatory children with CP are at risk of developing rickets. We recommend regular exposure to sunlight or Vitamin D supplementation as preventative measures. NO DISCLOSURES

Background. Vitamin D deficiency may increase predisposition to a number of paediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional paediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation and ethnicity. Methods. Individuals, age < 18 years, presenting to the regional paediatric orthopaedic service at Southampton, UK from 2008 to 2010 were investigated. Deprivation index scores were calculated from indices of deprivation. Results. 187 children (97 male, 90 female, mean age 7.1 years) underwent serum 25-(OH) D level measurement. 82% were white British and 11% of Asian ethnicity. The calculation of the total depravation index for the whole cohort showed 34 (18%) of subjects were in quartile 1 (least deprived), 54 (29%) in quartile 2, 49 (26%) in quartile 3 and 50 (27%) in quartile 4 (Most deprived). 60 (32%) had vitamin D insufficiency with 25-(OH) levels < 50nmol/l and 15 (8%) had vitamin D deficiency. No relation ship was identified between vitamin D level and social depravation score. Conclusions. There is a need for awareness of the prevalence of vitamin D deficiency in the paediatric orthopaedic population presenting with bone pain and lower limb deformity before commencing ‘observation or orthopaedic surgical treatment’

Abstract. Introduction. Vitamin D deficiency in the UK is well documented − 30–40% of the population. It is an essential component of calcium metabolism and adequate levels are important for bone healing. Studies have demonstrated an overall prevalence of vitamin D deficiency/insufficiency at 77% in trauma patients aged >18, deficiency alone was 39%. Adequate vitamin D levels have a positive effect on bone mineral density and callus formation at fracture sites. Methods. We conducted a retrospective consecutive case series of all patients aged 0–50 undergoing surgical management for any fracture in October 2021 to March 2022. We assessed if vitamin D levels were checked and if patients were prescribed replacement as per local guidelines. Results. A total of 131 patients were identified, (mean 29 years; 83 male and 48 female). Most cases were upper limb fractures (n=78, 60%), as opposed to lower limb (n=53, 40%). Only 20 (15%) had their levels checked, of which 13 (65%) were insufficient/deficient (10 insufficiency, 2 deficiency, 1 severe deficiency). Of these 13 patients, only 3 (23%) were prescribed replacement therapy. Conclusions. Only a small proportion of patients had their levels checked, however the majority were insufficient/deficient. The prevalence in our study is consistent with larger epidemiology studies, which reflect a higher rate of deficiency in fracture patients compared to the general population. Thus, we propose that all patients in this age group should undergo a vitamin d level check upon time of clerking and this should be accurately treated as per trust guidance

Introduction:. Blount's disease can be defined as idiopathic proximal tibial vara. Several etiologies including the mechanical theory have been described. Obesity is the only causative factor proven to be associated with Blount disease. Varus deformity is also a clinical feature of rickets and 31% of children with vitamin D deficiency rickets presented with varus deformities to the local Metabolic Bone clinics. The aim of this study is to assess if there is an association between vitamin D and Blount's disease. We hypothesize that children with Blount disease are more likely to be vitamin D deficient. Method:. This a retrospective study of pre-operative and post-operative patients with Blount's disease who were screened for vitamin D deficiency. Patients with known vitamin D deficiency and rickets were excluded. The study patients had the following blood tests: calcium, phosphate, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D. Body mass index (BMI) was also assessed. Results:. We recruited 50 patients. The mean age of these patients was 10.4 years (SD 3.88) with average BMI of 28.7 (SD 10.2). Fifty two % were overweight. Thirty (60%) patients were diagnosed with infantile, 16(32%) adolescent and 4(8%) juvenile Blount disease. Eight (16%) patients were found to be vitamin D depleted (less than 20 ng/ml). Of these eight patients, six had insufficient 25-hydroxyvitamin D levels (12–20 ng/ml) and while the other two were vitamin D deficient (less than 12 ng/ml). Conclusion:. Vitamin D deficiency is a public health problem worldwide. This study confirms that the prevalence of Vitamin D deficiency in children with Blount's disease is similar to healthy children and infants living in Johannesburg. There is no evidence that Vitamin D deficiency is a factor in causing Blount's disease. Routine screening for Vitamin D deficiency in children with Blount disease is not recommended

Introduction. Vitamin D deficiency is common in patients undergoing total hip (THA) or total knee arthroplasty (TKA) which may affect prosthesis survival and 90-day readmission rates. The purpose of this study was to assess whether preoperative Vitamin D deficiency or insufficiency have an influence on revision, readmission, and complication rates following THA and TKA. We hypothesized that low Vitamin D levels in patients undergoing THA and TKA have a negative effect on revision rates. Methods. Patients who underwent primary THA or TKA in a 2-year period university hospital were identified and stratified into 3 groups based on preoperative 25-hydroxyvitamin D serum levels: normal levels of 30 ng/ml or greater, (2) deficient levels of 20–29.9 ng/ml, and (3) insufficient levels of less than 20 ng/ml. Patient demographics and postoperative course were collected from the electronic medical record. Results. This study found that 45% out of 197 THA had Vitamin D levels less than 30ng/ml and significantly higher odds (14.1, p=0.018) of requiring revision surgery at a mean follow-up of 34 ± 11.2 months. Out of 167 TKA, 46% were Vitamin deficient/insufficient without an influence on revision rate. Vitamin D levels did not influence 90-day readmissions, wound complications, or reaching discharge goals. Low Vitamin D levels correlated with high BMI and young patient age for THA. Conclusion. Based on the findings of this study, the authors recommend preoperative Vitamin D3 supplementation (2,000–4,000 IU daily) for patients with a BMI greater than 30kg/m. 2. undergoing THA. Patient with Vitamin D deficiency may require referral for endocrinologic work-up. Based on the findings of this study, the authors have adopted postoperative Vitamin D3 supplementation with 2,000–4,000 IU daily for 3 months as part of the rehabilitation protocol for all patients undergoing THA

Vitamin D is vital for bone health because it assists in the absorption and utilisation of calcium. Vitamin D deficiency may predispose individuals to developing osteoporosis and subsequent osteoporotic fracture. There are various studies in elderly females with hip fractures correlating the low bone mineral density (BMD) with vitamin D levels. But very few studies have evaluated the influence on elderly males. Therefore this study was conducted. All male patients aged more than 50 years presenting to orthopaedic department, in JIPMER, Puducherry, with either fracture neck of femur or intertrochanteric fracture were included. Serum vitamin D level was assessed in them and BMD of both the hips was evaluated by DEXA scan. The vitamin D levels, T-scores, Z-scores were then analysed and correlated. Of the total 41 patients evaluated 21 (51%) had fracture neck of the femur and 20 (49%) patients had intertrochanteric fractures. We found that 11 (26.8%) patients had osteoporosis, 17 (41.5%) had osteopenia, and 13 (31.7%) had normal values. The mean value of total T-scores on fracture side was −1.55 and on no fracture side was −1.88. Among them 9 (22%) patients had vitamin D level <20 ng /mL, 15 (36%) had levels between 20ng–30ng/mL and 17 (41%) had >30ng/mL. Total T-score and Z-score on fracture side and no fracture side showed no correlation with vitamin D (p value >0.05) in these patients. We found significant osteoporosis in both neck and trochanteric regions on both fracture and no fracture sides, yet we had some patients with trochanteric fracture and some with neck fracture on only one side. In view of this other factors like mode of injury, velocity of injury, muscle wasting might have contributed significantly to the type of fracture and side involved. The BMD was found to be lower in patients with neck of femur fracture compared to intertrochanteric fracture, but no correlation was found between vitamin D and BMD scores at neck and trochanteric region. From this study it appears that there is no direct relationship between the vitamin D level and BMD in elderly males with hip fractures. It may emphasise that in male patients with hip fractures vitamin D may not have critical role in development of osteoporosis. The treatment of such patients with vitamin D supplements to prevent hip fractures is still debatable. However further studies in very large groups and controls may bring more light on this subject

Aims

Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined.

Aims

Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic infection through a systematic review of available evidence.