Metabolic Bone Disease
Spectrum Of Bowlegs In Children With Mbd
Bow legs in children….18 months to 3 years
LIST OF METABOLIC BONE DISEASE
Ehlers Danlos Syndrome
Mechanical Axis Deviation(MAD)
Treated as Rickets for many years
Typical changes are present only in metaphysis
Normal Joint Orientation:(mechanical)
hip joint orientationLPFA
knee joint orientationmLDFA
ankle joint orientationLDTA
BOW LEGS DEFORMITY
PARENTS MENTION THAT THE DEFORMITY IS NOT IMPROVING
RADIOGRAPHS AND INVESTIGATIONS
ALK PO4: 450 (200 – 400) ??
Physiological Bow - legs
Angular deformity – Bow legs
Usually corrects itself
Bow legs persisting after age 2 years needs further investigations
Monitor progress with intercondylar distance
Normal Tibio-femoral angle development
- 11 year old girl with idiopathic genu valgum
9 YR OLD (x-LINKED)
LDFA: 70 and 75degrees.
Bilateral progressive genu valgum
Treated with bracing
Se Alk PO4: 1468
Vit D3: 45ng/ml
Se P: 1.5 mg/dl
Guided Growth Plates
20 months follow up Height Increased from 119 cms – 129 cms: Peak velocity was in last six months
GUIDED GROWTH PLATES
Bone disease and consequent deformity caused by alteration in the normal bone biochemical or biological pathway is called MBD.
Bone is a dynamic tissue and is in a constant state of flux due to various physiochemical and mechanical interaction within its structure.
The strength and resilience of the bone depends on the bone architecture, both gross and microscopic. Bone is made up of 60% collagen and 40% mineral which together form a framework to impart strength to the bone,
The bone has three parts: Diaphysis, Metaphysis, and Epiphysis.
Diaphysis: The longitudinal part of the bone that form the center or bulk of the bone.
Metaphysis: The most active metabolic part of the bone where many hormones and growth factors regulate bone metabolism and also the site of involvement of many MBDs.
Epiphysis: The growing end of the bone that imparts length and also form part of the joints.
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