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Metabolic Bone Disease

Information:


Spectrum Of Bowlegs In Children With Mbd
Bow legs in children….18 months to 3 years
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LIST OF METABOLIC BONE DISEASE


Rickets
Scurvy
Osteogenesis Imperfecta
Caffey Disease
Fibrous Dysplasia
Ehlers Danlos Syndrome
Juvenile Osteoporosis

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Mechanical Axis Deviation(MAD)

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Metaphyseal Dysplasia

Treated as Rickets for many years

Typical changes are present only in metaphysis

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Normal Joint Orientation:(mechanical)


hip joint orientation

LPFA

knee joint orientation

mLDFA
MPTA

ankle joint orientation

LDTA
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CASE 1


18 MONTH OLD CHILD
BOW LEGS DEFORMITY
PARENTS MENTION THAT THE DEFORMITY IS NOT IMPROVING
ORDER TESTS
TREATMENT
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RADIOGRAPHS AND INVESTIGATIONS


VIT D3: 45 NG/ML ( 30 – 60)
ALK PO4: 450 (200 – 400) ??

RADIOGRAPH: NORMAL


Physiological Bow - legs


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Angular deformity – Bow legs


common under age 2years
Usually corrects itself
Bow legs persisting after age 2 years needs further investigations
Monitor progress with intercondylar distance

Normal Tibio-femoral angle development


  • Varus

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  • Valgus

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  • 11 year old girl with idiopathic genu valgum

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  • Valgus

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  • 9 YR OLD (x-LINKED)


    T –F angle: 25 degrees Rt 20 Degres Lt
    LDFA: 70 and 75degrees.
    OPTIONS
    OSTEOTOMY
    BRACING
    GROWTH MODULATION
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    Genu Valgum


    Nine year old boy
    Short stature
    Bilateral progressive genu valgum
    Treated with bracing
    Se Alk PO4: 1468
    Vit D3: 45ng/ml
    Se P: 1.5 mg/dl

    Guided Growth Plates


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    20 months follow up Height Increased from 119 cms – 129 cms: Peak velocity was in last six months


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    GUIDED GROWTH PLATES


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    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.

Publications

Paediatric Fracture Management" Synopsis of Children Fracture Management & Orthopaedic Management of Duchenne Muscular Dystrophy: A guide for parents and caregivers...