rickets
TRANSCRIPT
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