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Dr. Sonjoy Dey
Resident, Phase A (Hepatology)
Dr. Md. Zahidul Amin
FCPS Student
 Master P
 male
 11 years
 From c
 Pain in the front of chest and lower back for 5
days
 History of repeated fracture at multiple sites
from infancy
 According to the statement of the patient he was
relatively alright up to last Sunday
 When he was playing in school , he felt into ground &
felt pain in the front of the chest and lower back region
 The pain was sharp catching localized in nature
aggravate in activity and relieved by rest .
 According to the statement of his mother her baby
suffered from fracture in left lower forearm without any
trauma at the age of the 6 days .
 Then he suffered from repeated fracture in multiple
sites over the next one year involving rt upper forearm ,
rt mid forearm & left upper thigh .
 Last fracture occurred at the age of 2 year . in every
occasion he was treated with plaster immobilization .
 His birth was uneventful through normal per vaginal
delivery .
 He had normal weight gain throughout the childhood .
 His appetite was normal , no history of altered bowel
habit.
 He had no history of inadequate sun light exposure or
childhood abuse .
 There was no history of abnormal dentations or hearing
difficulty.
 He had 2 sisters , no one was suffering from such
disease .
 No maternal and paternal uncles and aunts had suffered
from such illness .
 Appearance – normal
 Built – normal
 Nutrition – average
 Anaemia : absent
 Jaundice : absent
 Pulse : 84/ min
 RR :16/min
 Temp : 98.4 F
 Height :128 cm
 Weight : 43 kg
 BMI : 25.84
 Skin & nail : healthy
 No lymph node palpable
 No dental abnormality
 There is deformity in rt arm .
 No shortening of any limb
 Tenderness over rt 5th
rib in mid clavicular line & over 2nd
lumber spine .
 Gait –Normal
 Leg - Normal
 Spine – normal
 Range of movement is normal in all joints
 Higher cerebral function and memory normal
 All cranial nerves are normal
 No conductive or sensory neuronal deafness
 Fundoscopy normal
 Sensory and motor system intact .
Examination of other systems reveals no abnormality
Rickets
Hyperparathyroidism
Osteogenesis Imperfecta
Childhood Paget’s disease
Date Name of inv result
1 24/09/13 CBC Hb:12.1gm/dl , ESR :45 mm in 1st
hour
Tc:9000/cmm , N :65% ,L:29% ,Pl count
2,40,000/cmm
2 24/09/13 Urine RME Protein : nil, sugar: nil , Pus cell :3-6/HPF
,RBC: nil , epi cell : 3-5/HPF
3 24/09/13 RBS 4.4 mmol/L
4 24/09/13 S creatinine 0.6 mg/dl
5 24/09/13 S calcium 9.4 mg/dl
6 24/09/13 S alkaline
phosphatase
378 U/L (50 -135U/L)
7 24/09/13 S inorganic
phosphate
4.2 mg/dl
8 24/09/13 S albumin 45 gm/L
Date Name of inv result
9 24/09/13 Usg of whole abdomen normal
10 24/09/13 Chest X-ray PA view normal
11 24/09/13 X-ray lumbo sacral spine normal
12 24/09/13 S PTH Pending….
Date Name of inv result
1 27/12/05 CBC Hb:10.6gm/dl , ESR :25 mm in 1st
hour
Tc:10,500/cmm , N :50% ,L:45% ,Pl count
2,40,000/cmm
2 27/12/05 PBF Non specific
3 27/12/05 S bilirubin T .5mg/dl
4 27/12/05 S creatinine 0.8 mg/dl
5 27/12/05 S calcium 9.5 mg/dl
6 27/12/05 S inorganic
phosphate
5.1mg/dl
7 27/12/05 SGPT 22U/L
8 27/12/05 S electrolytes Na : 143 , k : 3.8 , cl :106 , Tco2 :24.50
Date Name of inv result
1 27/12/05 X-ray of both Wrist ,
elbow and forearm
Suggestive of Scurvy
2 16/06/11 X ray pelvis with both
hip A/P view
Femoral head & neck is wide,
osteopanic with thin outer cortex .
Sclerotic reaction is seen in
acetabulum mostly in upper part .
Suggestive of Osteogenesis
Imperfecta
 What the actual diagnosis?
 What should be the next management plan?
A case of recurrent low trauma fracture
Recurrent fracture with any one of the following:
Blue sclerae
Dentinogenesis Imperfecta
Family H/O disease
 No curative RX
 Supportive treatment
Avoid contact sports
Sweeming
Physiotherapy
Psychological support
Surgery
 Regular follow up
THANK YOU
 Oral alendronate — The effect of daily oral
alendronate (5 mg or 10 mg based on body
weight: below or above 40 kg, respectively)

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A case of recurrent low trauma fracture

  • 1. Dr. Sonjoy Dey Resident, Phase A (Hepatology) Dr. Md. Zahidul Amin FCPS Student
  • 2.  Master P  male  11 years  From c
  • 3.  Pain in the front of chest and lower back for 5 days  History of repeated fracture at multiple sites from infancy
  • 4.  According to the statement of the patient he was relatively alright up to last Sunday  When he was playing in school , he felt into ground & felt pain in the front of the chest and lower back region  The pain was sharp catching localized in nature aggravate in activity and relieved by rest .
  • 5.  According to the statement of his mother her baby suffered from fracture in left lower forearm without any trauma at the age of the 6 days .  Then he suffered from repeated fracture in multiple sites over the next one year involving rt upper forearm , rt mid forearm & left upper thigh .  Last fracture occurred at the age of 2 year . in every occasion he was treated with plaster immobilization .
  • 6.  His birth was uneventful through normal per vaginal delivery .  He had normal weight gain throughout the childhood .  His appetite was normal , no history of altered bowel habit.  He had no history of inadequate sun light exposure or childhood abuse .  There was no history of abnormal dentations or hearing difficulty.
  • 7.  He had 2 sisters , no one was suffering from such disease .  No maternal and paternal uncles and aunts had suffered from such illness .
  • 8.  Appearance – normal  Built – normal  Nutrition – average  Anaemia : absent  Jaundice : absent  Pulse : 84/ min  RR :16/min  Temp : 98.4 F
  • 9.  Height :128 cm  Weight : 43 kg  BMI : 25.84  Skin & nail : healthy  No lymph node palpable  No dental abnormality
  • 10.  There is deformity in rt arm .  No shortening of any limb  Tenderness over rt 5th rib in mid clavicular line & over 2nd lumber spine .  Gait –Normal  Leg - Normal  Spine – normal  Range of movement is normal in all joints
  • 11.  Higher cerebral function and memory normal  All cranial nerves are normal  No conductive or sensory neuronal deafness  Fundoscopy normal  Sensory and motor system intact . Examination of other systems reveals no abnormality
  • 13. Date Name of inv result 1 24/09/13 CBC Hb:12.1gm/dl , ESR :45 mm in 1st hour Tc:9000/cmm , N :65% ,L:29% ,Pl count 2,40,000/cmm 2 24/09/13 Urine RME Protein : nil, sugar: nil , Pus cell :3-6/HPF ,RBC: nil , epi cell : 3-5/HPF 3 24/09/13 RBS 4.4 mmol/L 4 24/09/13 S creatinine 0.6 mg/dl 5 24/09/13 S calcium 9.4 mg/dl 6 24/09/13 S alkaline phosphatase 378 U/L (50 -135U/L) 7 24/09/13 S inorganic phosphate 4.2 mg/dl 8 24/09/13 S albumin 45 gm/L
  • 14. Date Name of inv result 9 24/09/13 Usg of whole abdomen normal 10 24/09/13 Chest X-ray PA view normal 11 24/09/13 X-ray lumbo sacral spine normal 12 24/09/13 S PTH Pending….
  • 15. Date Name of inv result 1 27/12/05 CBC Hb:10.6gm/dl , ESR :25 mm in 1st hour Tc:10,500/cmm , N :50% ,L:45% ,Pl count 2,40,000/cmm 2 27/12/05 PBF Non specific 3 27/12/05 S bilirubin T .5mg/dl 4 27/12/05 S creatinine 0.8 mg/dl 5 27/12/05 S calcium 9.5 mg/dl 6 27/12/05 S inorganic phosphate 5.1mg/dl 7 27/12/05 SGPT 22U/L 8 27/12/05 S electrolytes Na : 143 , k : 3.8 , cl :106 , Tco2 :24.50
  • 16. Date Name of inv result 1 27/12/05 X-ray of both Wrist , elbow and forearm Suggestive of Scurvy 2 16/06/11 X ray pelvis with both hip A/P view Femoral head & neck is wide, osteopanic with thin outer cortex . Sclerotic reaction is seen in acetabulum mostly in upper part . Suggestive of Osteogenesis Imperfecta
  • 17.  What the actual diagnosis?  What should be the next management plan?
  • 19. Recurrent fracture with any one of the following: Blue sclerae Dentinogenesis Imperfecta Family H/O disease
  • 20.  No curative RX  Supportive treatment Avoid contact sports Sweeming Physiotherapy Psychological support Surgery  Regular follow up
  • 22.  Oral alendronate — The effect of daily oral alendronate (5 mg or 10 mg based on body weight: below or above 40 kg, respectively)