“ Rickets is essentially osteomalacia occurring in an immature skeleton — by definition, the growth plates must not have fused. The most c...
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Rickets is essentially osteomalacia occurring in an immature skeleton—by definition, the growth plates must not have fused.
The most common underlying cause is a dietary deficiency of vitamin D, which results in a failure of bone mineralisation during bone growth.
• Hypophosphatasia is a rare inherited metabolic disorder that has similar radiographic features to rickets (see below for an important exception)—it is also associated with craniosynostosis.
APPENDICULAR X-RAY
• Widened growth plate in a child is due to rickets until proven otherwise.
• Changes are best seen at the ends of growing bones, particularly the wrists and knees.
• Metaphyses are cupped or splayed.
• Bowing deformity due to softening.
• Coarsened trabeculae.
• Poorly defined epiphysis, which is poorly mineralised.
• Delayed bone age.
• Lucent expansions into the metaphyses (uncalcified bone matrix) suggest hypophosphatasia.
SKULL X-RAY
• Delayed closure of the fontanelles
• Craniotabes
• Basilar invagination
PELVIS X-RAY
• Triradiate appearance due to protrusion
CHEST X-RAY
• Enlargement, cupping and fraying of the costochondral junction (‘rachitic rosary’)
Rickets. Frontal wrist radiograph demonstrating metaphyseal cupping and splaying of the ulnar and radius.
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