STEP TO PG-MD/MS -DR.AKIF A.B

RICKETS

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

STEP TO PG-MD/MS -DR.AKIF A.B

CRANIOTABES-Earliest manifestation

-Softening of skull at suture lines

STEP TO PG-MD/MS -DR.AKIF A.B

STEP TO PG-MD/MS -DR.AKIF A.B

HARISON’S GROOVE

STEP TO PG-MD/MS -DR.AKIF A.B

-Thickening of growth plate (Physis)

-Widening of Growth plate (Physis) : Rachitic rosary

-Widening of epiphyses

STEP TO PG-MD/MS -DR.AKIF A.B

RACHITIC ROSARY

STEP TO PG-MD/MS -DR.AKIF A.B

GENU VALGUMOR

KNOCK KNEES

STEP TO PG-MD/MS -DR.AKIF A.B

PECTUS CARINATUM(PIGEON CHEST)

STEP TO PG-MD/MS -DR.AKIF A.B

POT BELLY

STEP TO PG-MD/MS -DR.AKIF A.B

STEP TO PG-MD/MS -DR.AKIF A.B

Enlargement of Costochondral Junction

1)Rickets

2)Scurvy

3)Chondrodystrophy

STEP TO PG-MD/MS -DR.AKIF A.B

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

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

TYPE 2 RICKETSPhosphate deficiency

Decrease mineralisation

of bone

Compensatory increase in osteoblastic

activity

Increase Alkaline Phosphatase

Normal calcium

No secondary hyperparathyroidism

Normal PTH

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

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