METABOLIC BONE DISEASE Rickets

METABOLIC BONE DISEASE Rickets

In rickets, the primary problem is inadequate mineralisation of growing bone ( Table 44.5 ). In severe cases the classic radiographic features are seen at all physes with significant deformity ( Figure 44.11 ). Medical treatment improves mineralisation and deformity corrects with growth. Once the medical condition has stabilised, surgery may be indicated to treat residual limb deformity . Guided growth techniques are often used in preference to osteotomies. Burrill Bernard Crohn , 1884–1983, gastroenterologist, Mount Sinai Hospital, New Y ork, NY , USA, described regional ileitis in 1932.

TABLE 44.5 Common causes of rickets. Nutritional Reduced intake of vitamin D and calcium Environmental Inadequate exposure to sunlight Gastrointestinal Crohn’s disease, gluten-sensitive enteropathy disease Genetic X-linked hypophosphataemia (excess FGF23 production) Renal disease End-stage renal failure, renal tubular anomalies Secondary hyperparathyroidism may be present Figure 44.10 Standing leg length/alignment radiograph of a child with polyostotic /f_i brous dysplasia. The diaphyseal lesions have a ‘ground

glass’ appearance. The bones ar e often deformed and the limb may be short, as seen on the right. The femur has fractured pr eviously and one intramedullary nail remains in place. Figure 44.11 Radiographs in cases of rickets demonstrate widened physes with cupped, /f_l ared metaphyses.

METABOLIC BONE DISEASE Rickets

In rickets, the primary problem is inadequate mineralisation of growing bone ( Table 44.5 ). In severe cases the classic radiographic features are seen at all physes with significant deformity ( Figure 44.11 ). Medical treatment improves mineralisation and deformity corrects with growth. Once the medical condition has stabilised, surgery may be indicated to treat residual limb deformity . Guided growth techniques are often used in preference to osteotomies. Burrill Bernard Crohn , 1884–1983, gastroenterologist, Mount Sinai Hospital, New Y ork, NY , USA, described regional ileitis in 1932.

TABLE 44.5 Common causes of rickets. Nutritional Reduced intake of vitamin D and calcium Environmental Inadequate exposure to sunlight Gastrointestinal Crohn’s disease, gluten-sensitive enteropathy disease Genetic X-linked hypophosphataemia (excess FGF23 production) Renal disease End-stage renal failure, renal tubular anomalies Secondary hyperparathyroidism may be present Figure 44.10 Standing leg length/alignment radiograph of a child with polyostotic /f_i brous dysplasia. The diaphyseal lesions have a ‘ground

glass’ appearance. The bones ar e often deformed and the limb may be short, as seen on the right. The femur has fractured pr eviously and one intramedullary nail remains in place. Figure 44.11 Radiographs in cases of rickets demonstrate widened physes with cupped, /f_l ared metaphyses.

METABOLIC BONE DISEASE Rickets

In rickets, the primary problem is inadequate mineralisation of growing bone ( Table 44.5 ). In severe cases the classic radiographic features are seen at all physes with significant deformity ( Figure 44.11 ). Medical treatment improves mineralisation and deformity corrects with growth. Once the medical condition has stabilised, surgery may be indicated to treat residual limb deformity . Guided growth techniques are often used in preference to osteotomies. Burrill Bernard Crohn , 1884–1983, gastroenterologist, Mount Sinai Hospital, New Y ork, NY , USA, described regional ileitis in 1932.

TABLE 44.5 Common causes of rickets. Nutritional Reduced intake of vitamin D and calcium Environmental Inadequate exposure to sunlight Gastrointestinal Crohn’s disease, gluten-sensitive enteropathy disease Genetic X-linked hypophosphataemia (excess FGF23 production) Renal disease End-stage renal failure, renal tubular anomalies Secondary hyperparathyroidism may be present Figure 44.10 Standing leg length/alignment radiograph of a child with polyostotic /f_i brous dysplasia. The diaphyseal lesions have a ‘ground

glass’ appearance. The bones ar e often deformed and the limb may be short, as seen on the right. The femur has fractured pr eviously and one intramedullary nail remains in place. Figure 44.11 Radiographs in cases of rickets demonstrate widened physes with cupped, /f_l ared metaphyses.