Download - Rickets
![Page 1: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/1.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
RICKETS
![Page 2: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/2.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
RICKETSA Abdominal ProtruberanceB Bowing of bonesC Costochondral junction Prominency (Rosary), CraniotabesD Diaphragm pull (Harrisons groove), Delayed closure of
anterior fontanelleE Enamel defect and delayed dentitionF Forward Sternum (Pectus Carinatum) or Pigeon chestG Growth plate wideningH Hypocalcemia causing HyperPTHI IrritabilityJ Joint deformities : Genu valgum/varum/coxa varaK KyphosisL Loosers zoneM Milestones delayed
- Ref . : Quick Review of Orthopaedics by Dr. Apurv Mehra
![Page 3: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/3.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
CRANIOTABES-Earliest manifestation
-Softening of skull at suture lines
![Page 4: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/4.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
![Page 5: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/5.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
HARISON’S GROOVE
![Page 6: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/6.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
-Thickening of growth plate (Physis)
-Widening of Growth plate (Physis) : Rachitic rosary
-Widening of epiphyses
![Page 7: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/7.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
RACHITIC ROSARY
![Page 8: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/8.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
GENU VALGUMOR
KNOCK KNEES
![Page 9: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/9.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
PECTUS CARINATUM(PIGEON CHEST)
![Page 10: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/10.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
POT BELLY
![Page 11: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/11.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
![Page 12: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/12.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
Enlargement of Costochondral Junction
1)Rickets
2)Scurvy
3)Chondrodystrophy
![Page 13: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/13.jpg)
STEP TO PG-MD/MS -DR.AKIF A.B
![Page 14: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/14.jpg)
TYPES OF RICKETSType 1 Type 2 Type 3
Due to calcium deficiency
Due to phosphate deficiency
End organs are resistant to active form of Vitamin D
S.Calcium Normal or low Normal Low
S.Phosphate Low Low Normal
Alkaline phosphatase
High High High
PTH High Normal
Serum Alkaline Phosphatase is a consistent marker and is raised in all types
![Page 15: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/15.jpg)
TYPE 1 RICKETSCalcium
deficiency
Increased activity of PTH
Increases Phosphate
excretion in urine
Increases Calcium
reabsorption
Bone mineralisation decreases
Compensatory increase in osteoblastic activity
Increased Alkaline
phosphatase
both calcium and phosphate decreases
1) Calcium = Normal to Low2) Phosphate = Low3) Alkaline phospahatase = High4) PTH = High
![Page 16: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/16.jpg)
TYPE 2 RICKETSPhosphate deficiency
Decrease mineralisation
of bone
Compensatory increase in osteoblastic
activity
Increase Alkaline Phosphatase
Normal calcium
No secondary hyperparathyroidism
Normal PTH
![Page 17: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/17.jpg)
RADIOLOGY IN RICKETS-Earliest radiological changes are seen around wrist i.e Radius and Ulna
1) Cupping and flaring of metaphysis
2) Widening of epiphysis
3) White line of calcification (Frankel line) : Sign of HEALING
![Page 18: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/18.jpg)
TREATMENT OF RICKETSSTRATERGY 1
Start with 6lac IU(15,000mg) of Vitamin D3 is administered every
weekly
Follow up with x-ray and blood investigations
Healing started
Put child on Vitamin D3 400 IU (10mg) for
maintenance
STRATERGY 2
2000-5000 IU of Vit.D3 everyday for 4-
6weeks
Surgery if any is only done once healing starts
![Page 19: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/19.jpg)
![Page 20: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/20.jpg)
![Page 21: Rickets](https://reader036.vdocuments.mx/reader036/viewer/2022070520/58f9b135760da3da068bbe88/html5/thumbnails/21.jpg)