Metabolic Bone Diseases in Children MCQs

The methods to evaluate recovery in rickets are X ray There will be an appearance of a white line in the metaphysis. This is called the 'White line of Frankel' Blood tests first change to be seen - increase in phosphate levels End point - normal ALP Surgery should be done only after the rickets have been completely cured and bone healing has completely taken place. This is indicated by normal ALP. Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 81

Stoss regimen is a vitamin D supplementation method used for the treatment of rickets. Here a single dose of vitamin D - 3L to 6L IU is given as an oral dose or as an IM injection. Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 311

Fracture healing is normal in osteopetrosis. Osteopetrosis is also called Marble bone disease/Albers Schonberg disease It is a congenital condition characterized by defective osteoclastic resorption of immature bone resulting in its accumulation through out the skeleton, causing increased frequency of long bone fractures, cranial nerve palsies, pancytopenia and low back pain. Clinical feature include Low back pain Pathological fractures Progressive anemia Severe infections : Mandible osteomyelitis Easy bruising Failure to thrive Cranial N 2, 7, 8 palsy leading to blindness and deafness Reference: Miler's 8th Edition of Review of Orthopaedics, page no. 688

Osteomyelitis of jaw in a child is the classical feature of osteopetrosis. Osteopetrosis is also called Marble bone disease/Albers Schonberg disease It is a congenital condition characterized by defective osteoclastic resorption of immature bone, resulting in its accumulation throughout the skeleton, causing increased frequency of long bone fractures, cranial nerve palsies, pancytopenia and low back pain. Clinical feature include: Low back pain Pathological fractures Progressive anemia Severe infections : Mandible osteomyelitis Easy bruising Failure to thrive Cranial N 2, 7, 8 palsy leading to blindness and deafness Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 317

Phosphate levels will be reduced in rickets. The biochemical changes in rickets are: Calcium - ↓ / N PTH - ↑ Serum PO4 - ↓ Alkaline Phosphatase (ALP) - ↑ Serum Vit D - ↓ Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 311

There are 2 conditions that can produce rosary in the chest wall - rickets and scurvy. In rickets, the rosary is painless and rounded. However, in scurvy, they are painful and angular. This child has painful angular rosary and there is gum bleeding, both point towards scurvy. Reference: J. Maheshwari's 5th Edition of Essential Orthopaedics page no. 315

Long bones of legs get deformed only after the child starts weight bearing, so a 7 month old child will never develop deformities of lower limb. Clinical features of rickets: Craniotabes(earliest sign) Frontal bossing Rachitic rosary Harrison's groove Pectus carinatum(pigeon chest) Broadening of the ends of long bones, most prominently around wrists and knees. It is seen around 6-9 months of age. Delayed teeth eruption is noticed in infants. Muscular hypotonic: The child's abdomen becomes protuberant(pot belly) because of marked muscular hypotonia. Visceroptosis and lumbar lordosis can occur. Deformities: Deformities of the long bones develop, once the child starts walking. The most common deformity is bilateral genu varum, also called bow legs. Reference: Maheshwari Ortho, 5 th edition, Page no. 311.

Common primary sites for bone metastasis In males: Prostate followed by lung In females: Breast followed by lung In children: Neuroblastoma Overall: Breast followed by prostate and then lung Reference: Maheshwari Essential ortho, 5 th edition, Page no. 236.