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Rickets
1. BASSEY, A E M.B, B.S
DEPARTMENT OF ORTHOPAEDIC AND TRAUMA SURGERY
U.A.T.H, GWAGWALADA
2. • INTRODUCTION
• DEFINITION
• STATEMENT OF IMPORTANCE
• EPIDEMIOLOGY
• METABOLIC BONE PHYSIOLOGY
• BONE COMPOSITION
• BONE MINERALISATION AND TURNOVER
• AETIOPATHOGENESIS
• MANAGEMENT
• CLINICAL ASSESSMENT
• BIOCHEMICAL ASSESSMENT
• RADIOGRAPHIC ASSESSMENT
• TREATMENT
• FOLLOW-UP
• COMPLICATIONS
• OF RICKETS
• OF TREATMENT
• PREVENTION
• CONCLUSION
3. RICKETS IS A METABOLIC BONE DISEASE
UNIQUE TO CHILDREN AND ADOLESCENTS,
RESULTING FROM INADEQUATE
MINERALISATION OF OSTEOID
IT IS THE COMMONEST METABOLIC BONE
DISEASE IN CHILDREN AND FREQUENTLY
ATTENDED BY DEFORMITIES. SURGEONS
THEREFORE, MUST HAVE ADEQUATE
KNOWLEDGE IN THE DIAGNOSIS AND
TREATMENT OF THIS PROBLEM.
4. COMMONEST METABOLIC BONE DISEASE
GLOBALLY
NUTRITIONAL TYPE IS COMMONEST IN AFRICA,
MIDDLE EAST & SE ASIA
RENAL RICKETS COMMONEST IN THE WEST
INCIDENCE RISING IN THE WEST DUE TO
INCREASED USE OF SUNSCREEN LOTIONS & MORE
CHILDREN STAYING INDOORS AND WATCHING TV
OR PLAYING VIDEO GAMES
6. SOURCE & REGULATION OF BONE
MINERALISATION
ROLE OF VITAMIN D
ROLE OF PARATHYROID HORMONE
ROLE OF CELLS IN BONE TURNOVER
OSTEOBLASTS
OSTEOCLASTS
8. CLINICAL ASSESSMENT
◦ HISTORY
AGE – CHILD/ADOLESCENT
DEFORMITY OF THE LOWER LIMBS
SHORT STATURE
LISTLESSNESS
SEIZURES
NUTRITION – MALNUTRITION, VEGAN, PROLONGED
BREASTFEEDING WITHOUT SUPPLEMENTATION
FAMILY HISTORY
DRUG HISTORY
◦ EXAMINATION
↓HEIGHT-FOR-AGE
GENERALISED HYPOTONIA
DELAYED CLOSURE OF ANTERIOR FONTANELLE
THICKENING OF WRIST JOINT, KNEE, ANKLE
15. SERUM CALCIUM
SERUM PHOSPHATE
Ca x P PRODUCT
ALKALINE PHOSPHATASE
25-HYDROXYCHOLECALCIFEROL
SERUM E/U/Cr
URINALYSIS
16. SPLAYING, CUPPING AND FRAYING OF
METAPHYSES
OSTEOPENIA
BONY DEFORMITIES
CRANIOTABES
PATHOLOGIC FRACTURES
17.
18.
19. TREATMENT IS MEDICAL
CHOLECALCIFEROL 2000 – 5000IU/DAY +
CALCIUM SUPPLEMENTS
IN RENAL RICKETS, HIGH DOSES –
CHOLECALCIFEROL 150,000IU + Ca.
CALCITRIOL MAY BE GIVEN AS WELL
RESIDUAL DEFORMITY IS CORRECTED
SURGICALLY (OSTEOTOMY)
21. DUE TO DISEASE
◦ RESIDUAL DEFORMITY
◦ PATHOLOGIC FRACTURE
◦ COMPLICATED CHILDBIRTH
◦ RESPIRATORY FAILURE
DUE TO TREATMENT
◦ HYPERCALCAEMIA
◦ NEPHROCALCINOSIS
◦ UROLITHIASIS
22. PARENT EDUCATION
ADEQUATE EXPOSURE TO SUN
AVOID USE OF SUNSCREEN LOTIONS
DIETARY SOURCES - OILY FISH (MACKEREL, TUNA),
COD LIVER OIL, EGG YOLK, BEEF LIVER
BREAST MILK CONTAINS VIT D 20-40IU/L
THE AMERICAN ACADEMY OF PAEDIATRICS (2008)
RECOMMENDS:
◦ BREASTFED INFANTS TO RECEIVE 400IU VIT D/DAY
◦ WHEN WEANED SHOULD BE PLACED ON VIT D-FORTIFIED
FORMULA OR FOR AN OLDER CHILD FORTIFIED MILK
23. NUTRITIONAL RICKETS REMAINS A COMMON
PROBLEM IN OUR ENVIRONMENT.
DESPITE ITS TREATMENT BEING QUITE OFTEN
REWARDING, GREATER AMOUNT OF EFFORT
NEED TO BE GEARED TOWARD ITS
PREVENTION IN OUR POPULACE.