Orthopedics Flashcards
What is Rickets?
Rickets occurs d/t deficiency in vitamin D.
It occurs before skeletal maturity, seen in children.
What is Osteomalacia?
It is also vitamin D deficiency seen in adults or after skeletal maturity
What are the causes of rickets?
Decrease in Vitamin D leads to hypocalcemia.
* Nutritional (MC)
* Malabsorption
* Lack of sunlight
* Liver and kidney diseases
* Drugs
Decrease in calcium
Decrease in phosphate
Osteoid Maturation Time
Time taken by the osteoid to become osteon.
Hypocalcemia increases the osteoid maturation time.
Mineral Apposition Rate
Speed at which the mineral gets deposited on the osteoid.
Hypocalcemia decreases the mineral apposition rate
What are laboratory finding in rickets?
- Ca+2: Decrease or normal
- PTH: Increased
- Phosphate: Decreased
- ALP: Increased (Bone turnover)
What are the skull manifestations in rickets?
- Craniotabes or Ping pong skull: Softening of skull (earilest change)
- Frontal bossing
- Delayed closure of fontanelle
What are the chest manifestations of rickets?
- Rachitic Rosary: Costochondral junction swellings (Blunt and non-tender)
- Pigeon chest or pectus carinatum: prominent sternum
- Harrison sulcus: Under the ribs where the diaphragm inserts.
- Bending of long bones once the child starts bearing weight not seen in infants
10 important clinical features in rickets
What are the clinical findings seen in knee in rickets?
- B/L Genu Valgum (Knock knees)
- B/L Genu varum (Bow knees)
- Wind swept deformity - varus on one side and valgus on other side
What are the Most common cause in children of
1.B/L genu varum
2.B/L Genu valgum
3.wind swept deformity
- B/L genu varum: Rickets > Idiopathic
- B/L genu valgum: idiopathic > rickets
- Wind swept deformity: Rickets
MCC overall : Rickets
What is the most common cause in adults of
1.B/L Genu varum
2.B/L genu valgum
3.Wind swept deformity
- B/L Genu varum: Osteoarthritis > Rheumatoid arthritis
- B/L genu valgum: Rheumatoid arthritis > Osteoarthritis
- Windswept deformity: Rheumatoid arthritis
MCC in adults: Rheumatoid arthritis
What is the radiological features of rickets?
Bowing of legs
What are the other radiological features in rickets?
- Joints are swollen d/t hypertrophic layer of growth plate keeps on expanding without mineralization
- Cupping of metaphysis
- Splaying of metaphysis
- Fraying of metaphysis
- Widening of epiphyseal plates
Most of deformities are reversible on Tx with vit.D
Osteoclasts cannot act on improperly ossified bone.
What is the treatment of rickets and Osteomalacia?
STOSS regimen:
* 3 lakh- 6lakh IU deep IM or oral (stat or over 1-5days)
* Daily: 2k - 5K IU for 4-6 weeks
* Weekly: 50k - 60k IU for 8-12 weeks
What is the treatment of deformity in rickets?
- Mermaid splint and vitamin D therapy
- Surgery for deformity correction.
- Young: Wait for remodeling
- Older child: Osteotomy after the bone activity is reduced which is assessed by bone turnover (Normal serum ALP)
What is healing rickets
Dense mineralization of growth plate.
Whiteline of frankel: Thick band of calcification on the metaphysis
What is the best method to assess the healing rickets?
X-ray > Serum ALP
What are the characteristics of osteomalacia?
- Occurs after skeletal maturity
- Females > Males
- seen in Young people
- Presentation: Polyarthralgia, bone pains, proximal myopathy
What deformity can be seen in osteomalacia?
Milkman’s fractures or Looser zone or Pseudo fractures or cortical infarctions.
What is Milkman’s fracture or Cortical infarctions?
- Pulsations from the arteries around the bone can cause stress fractures which heal by the callus which deficient in mineral.
- These appear as transverse bands of rarefraction which are perpendicular to long axis of bone
What is the most common location of cortical infarction or milkaman’s fractures?
MC sites: Neck of femur, clavicle, ribs, scapula, pubic ramus
What are the other conditions where looser zone or milkman’s fractures can be seen?
- Hypothyroidism
- Paget’s disease
- Fibrous dysplasia
- Osteogenesis imperfecta
- Renal osteodystrophy
- X linked hypophosphatemic rickets
What are the other deformities can be seen in osteomalacia?
- Triradiate pelvis
- Trefoil pelvis
- Protrusio acetabuli
- Champange glass pelvis (also seen in achondroplasia)
What are the tumors that induce osteomalacia?
- Fibrosarcoma
- Osteoblastoma
- Osteosarcoma
- Non-ossifying fibroma
What is scurvy?
Collagen maturity deformity because of vitamin C deficiency.
Laboratory values are normal as mineralisation is normal.
What are clinical manifesation of scurvy on bone?
