Sanjeeb Kumar Sarma (Down Town Hospital/Guwahati/India)  

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3 Years  

Male  

Generalized diseases  

other  

3 years old emaciated male patient brought to our hospital with inability to stand or walk properly.  

The skeletal effects of rickets are due to lack of calcification of osteoid. As a result most obvious changes are seen at metaphysis where the most rapid growth occurs. The earliest changes are loss of normal “zone of provisional calcification” adjacent to metaphysis featuring as indistinctness of metaphyseal margin. This progressed to a “frayed” appearance with widening of the growth plate due to lack of calcification of metaphyseal bone. Weight bearing and stress on the uncalcified bone give rise to “splaying” and “cupping” of the metaphysis. A similar but less marked effect occurs in the sub-periosteal layer causing loss of distinctness of cortical margin. Generalized osteopenia occurs, however, looser’s zones are distinctly uncommon.
In severe cases additional deformities like bowing of long bones particularly of lower bones, thoracic kyphosis with a pigeon chest, enlargement of anterior ribs causing ricketic rosary and bossing of the skull. In low birth weight premature babies features of rickets may be very severe with spontaneous fractures and respiratory difficulty. Affected infants are usually bellow 1000 g in weight or less than 28 weeks of gestation.
Treatment is dietary supplement of vitamin D.  

<- view X-Ray 1

X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.




<- view X-Ray 2

X-Ray 2: Coned down view of right wrist.





<- view X-Ray 3

X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.





<- view X-Ray 4

X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.

 

Expert's opinion  

Hypophosphatasia, NAI etc  

Prognosis is good with timely intervention.  

Patient is undergoing treatment.  

N/A  

N/A  

Rickets, vitamin D, splaying, fraying, cupping, child, childhood, pediatric radiology  

Sanjeeb Kumar. Rickets. PedRad [serial online] vol 10, no. 1.
URL: www.PedRad.info/?search=20100128133421