basics

1. NUTRITIONAL RICKETS
Dr.HARSHA NANDINI TALASILA
M.S. Ortho

2. RICKETS
• Rickets is a disease of the growing skeleton characterized by failure of
normal mineralization,seen predominanty at the growth
plates,resulting in softening of the bones and development of
deformities.

3. TYPES OF RICKETS
• NUTRITIONAL RICKETS
• RENAL RICKETS

4. NUTRITIONAL RICKETS
• VITAMIN D DEFICIENCY
• ISOLATED CALCIUM DEFICIENCY
• COMBINED CALCIUM AND VITAMIN D DEFICIENCY

5. VITAMIN D DEFICIENCY
• Diminished intake
 Malnutrition
• Diminished absorption
Malabsorption syndrome
Post gastrectomy
Small bowel resection
Hepatobiliary diseases like biliary atresia, cystic fibrosis
• Lack of exposure to sunlight

6. Vitamin D metabolism
• Hepatic factors:
Lack of hydroxylation
Increased degradation of vitamin D on prolonged anticonvulsant
therapy.
• Renal factors:
Lack of hydroxylation
Renal osteodystrophy

7. PATHO PHYSIOLOGY
• Inadequate exposure to sunlight
Insufficient production of 1,25 dihydroxy cholecalciferol
Decreased absorption of Calcium from gut
Decreased mineralization of the bone

8. CLINICAL FEATURES
• Craniotabes
• Delayed closure of anterior fontanelle.
• Bossing of the skull
• Ping pong ball like sensation
• Delayed teeth eruption

10. • Harrison’s sulcus
• Pigeon chest
• Rachitic rosary
• Muscular hypotonia
• Pot belly
• Deformities like genu varum,genu valgus and kyphosis

14. Radiological features
• Delayed appearance of epiphyses
• Widening of epiphyseal plates
• Cupping of the metaphysis
• Splaying of the metaphysis
• Bone deformities: knock knees,bow legs

16. INVESTIGATIONS
• Total calcium level : low
• Serum 1,25 dihydroxycholecalciferol : low
• Serum alkaline phosphatase : elevated

17. Ca ALKALINE
PHOSPHATASE
PTH 25 VIT D 1,25 VIT D
Vitamin D
deficient rickets
LOW HIGH HIGH LOW LOW
Gastrointestinal
rickets
LOW HIGH HIGH LOW LOW

18. TREATMENT
Medical treatment
• VITAMIN D : 6 lakh units as a single dose
• Observe for 3-4 weeks
• If line of sclerosis appears at the metaphyseal end,mainatinence dose
of 400 IU given per day.
• If it doesnot appear 6lakh units is repeated.
• If there is no response even after second dose,diagnosis of refractory
rickets is made.

19. • Orthopaedic Treatment
Conservative: mild deformities correct spontaneously.
Sometimes special splints like mermaid splints.
Operative methods: moderate or severe deformities often require
surgery like corrective osteotomies depending on the nature of
deformities.

20. THANKYOU