Aims

Although atlantoaxial rotatory fixation (AARF) is a common cause of torticollis in children, the diagnosis may be delayed. The condition is characterised by a lack of rotation at the atlantoaxial joint which becomes fixed in a rotated and subluxed position. The management of children with a delayed presentation of this condition is controversial. This is a retrospective study of a group of such children.

Aim: Since obesity is thought to be an aetiological factor for SCFE we have looked to see if the ‘Obesity epidemic’ in children has been associated with a similar trend in SCFE.

Method: A population based study, using a national database of NHS Scotland activity, was undertaken to analyse trends in SCFE from 1981 to 2005 and to look for a relationship with changes in obesity in Scotland. Data on the body mass indices of Scottish school children have been collected as part of the child Health Surveillance Programme.

Results: We found that the incidence of SCFE increased from 3.78 per 100,000 children in 1981 to 9.66 per 100,000 children in 2000 (R² = 0.715) – a two and a half fold increase over two decades. Furthermore, SCFE was seen at younger ages with a fall in the average age at diagnosis from 13.4 to 12.6 years for boys (p=0.007) and 12.2 to 11.6 for girls (p=0.047). SCFE is rare in young children – for 1981–1990 only two children presented with the diagnosis between the ages of six and eight; however for 1991–2000 seven presented in this age group. Along with the rest of the UK, the two decades we studied had seen markedly rising childhood obesity rates in Scotland. The prevalence of overweight (BMI> 85^th centile) 13–15 year old children doubled from 15% in 1981 to 29% in 2001 and the problem extends to 4 and 5 year olds, although it is not of the same severity.

Conclusion: The incidence of SCFE has increase two and a half times in two decades and may well be a consequence of the worsening obesity rates that have occurred over the same period.

Obesity is thought to be an aetiological factor for slipped capital femoral epiphysis (SCFE). We analysed changes in the incidence of SCFE in Scotland over the last two decades. During this period rates of childhood obesity have risen substantially and evidence for a relationship between these changes and the incidence of SCFE was sought.

We found that the incidence of SCFE increased from 3.78 per 100 000 children in 1981 to 9.66 per 100 000 in 2000 (R² = 0.715): a two and a half times increase over two decades. It was seen at a younger age, with a fall in the mean age at diagnosis from 13.4 to 12.6 years for boys (p = 0.007) and 12.2 to 11.6 for girls (p = 0.047). More children under eight years old were seen with SCFE in Scotland in the decade to 2000 than in the previous decade (p = 0.002, R² = 0.346).

A close correlation was observed between rising childhood obesity over the last 20 years in Scotland and an increasing incidence of SCFE.

Peripheral limb ischaemia is rare in children. We have treated only 12 infants and children with this condition in the past 15 years at the Royal Hospital for Sick Children in Glasgow.

There were nine neonates and three older children. Most were suffering from life-threatening illnesses or severe infection. Two were born with ischaemic arms with no apparent cause. We have analysed the factors leading to ischaemia, the outcome of the initial treatment and the later orthopaedic problems.

Two required amputation of both legs, one of an arm, two of feet and one of toes. Two had skin grafts. All surgery was performed after demarcation was well established and delayed closure was used after amputation.

Five children developed limb-length discrepancy or an angular deformity. To date two have required additional corrective surgery.