Rickets

TYPES:
  • Nutritional Rickets
  • Vitamin D Resistant Rickets
  1. X-linked dominant
  2. Defect in skeletal ossification
  3. Reduced serum phosphorus
  • Vitamin D Dependent Rickets (Type I & Type II)
  • Congenital Rickets
ETIOLOGY:
  • Nutritional rickets: vit D deficiency, Malabsorption
  • Rickets is due to Loss of calcium in urine,Increased mobilisation of calcium from bone
  • Accelerated loss of vit D: Phenytoin, Rifampicin, Barbiturates
  • Impaired hydroxylation in liver and Kidney:
  • Liver disease, Hypoparathyroidism, Renal failure, Renal Tubular Acidosis
  • Vit D Resistant rickets, Fanconi's syndrome, Wilson's disease.
CLINICAL FEATURES:
  • Delayed teeth development 
  • Defect in proximal tubular reabsorption is seen in vitamin D resistant rickets
  • Widening of growth plate
  • Craniosynostosis
  • Scoliosis
  • Triradiate pelvis
  • Wormian bones 
  • Quant's sign (a T-shaped depression in the occipital bone) 
  • Caries teeth
  • Rickets is seen before closure of growth plates
  • Susceptibility to fractures, weakness and hypotonia, and disturbances in growth
  • Parietal flattening
  • Costochondral junction swelling
  • Frontal bossing develops in the skull
  • Craniotabes: The calvariae are softened
  • Sutures may be widened
  • Genu valgum(knock knee)
  • Wide open fontanelles in infants
  • Rachitic rosary Prominence of the costochondral junctions(in infancy)
  • Harrison's groove :indentation of the lower ribs at the site of attachment of the diaphragm
  • Knock knee + Coxa Vara
  • Bow legs
  • Pot Belly
  • Hot cross bun sign 
  • Forward projection of sternum (Pectus Carinatum)
  • Caput Quadratum
  • Widening of wrist 
  • Wind swept deformity
  • Lumbar Lordosis
  • Short stature, coxa vara, Kyphoscoliosis
  • Rickets is characterized by defective mineralization of bones
  • Any child with rickets also has osteomalacia while the reverse is not necessarily true because Osteomalacia is found within the same spectrum of rickets, but occurs in persons of any age group, not only in children.
RADIOGRAPHIC FINDINGS:
  • Thickening and widening of epiphysis 
  • Cupping and fraying of metaphysis 
  • Irregular metaphyseal margins
  • Flaring of anterior ends of ribs
  • Ricketic rosary
  • Bowing of diaphysis
BIOCHEMICAL REACTIONS:
  • Serum calcium: normal or low
  • Serum phosphate: low
  • Alkaline phosphatase: high
  • Hypophosphatasia shows low level of alk. phosphatase 
  • PTH: High
  • Hypophophatemia 
DIAGNOSIS:
  • Blood tests:
  1. Serum calcium may show low levels of calcium, serum phosphorus may be low, and serum alkaline phosphatase may be high.
  2. Arterial blood gases may reveal metabolic acidosis
  • An X-ray or radiograph of an advanced sufferer from rickets tends to present in a classic way:
  1. Bow legs (outward curve of long bone of the legs) and a deformed chest.
  2. Changes in the skull also occur causing a distinctive "square headed" appearance. These deformities persist into adult life if not treated. 
  3. Long-term consequences include permanent bends or disfiguration of the long bones, and a curved back.
  4. The earliest feature of healing in rickets is seen in X ray of growing end of the bones.
Exam Question
  • Defect in proximal tubular reabsorption is seen in vitamin D resistant rickets
  • Craniotabes, Bow legs & Increase alkaline phosphatase are findings of rickets
  • Rickets in infancy is characterised by Craniotabes,Rachitic rosary, Wide open fontanelles
  • Radiological examination of long bones are investigations showing the earliest evidence for healing in treatment of rickets
  • Flaring of anterior ends of the ribs is characteristically seen in Rickets
  • A child presented with clinical features of rickets but low level of serum alkaline phosphatase is seen in Hypophosphatasia
  • Any child with rickets also has osteomalacia while the reverse is not necessarily true because Osteomalacia is found within the same spectrum of rickets, but occurs in persons of any age group, not only in children.
  • vitamin D-resistant rickets X-linked dominant showing Defect in skeletal ossification & Reduced serum phosphorus
  • Triradiate pelvis is seen in Rickets
  • Serum marker of rickets is Alkaline phoshpatase 
  • Rickets is due to Loss of calcium in urine,Increased mobilisation of calcium from bone
  • Basic pathology in rickets is Defect in mineralization
  • Cupping of metaphysis & Defective Mineralization is seen in rickets
  • Craniotabes & Widening of wrist are seen in nutritional rickets
  • Bow legs,Pot belly & Craniotabes is seen in Rickets 
  • Most common cause of genu valgum in children is Rickets
  • Wind swept deformity is seen in Rickets
  • Costochondral junction swelling is seen in Rickets
  • Prominent fontanelle,Hot cross bun sign & Caries teeth is seen in active rickets
  • Cupping of metaphysis,Ricketic rosary are the radiographic feature of rickets
  • Quant's sign (a T-shaped depression in the occipital bone) may be present in rickets 
  • Hypophophatemia is seen in Rickets
  • Wormian bones are seen in rickets
Don't Forget to Solve all the previous Year Question asked on Rickets