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Questions and Answers
Infantile rickets can be treated with a diet rich in Vitamin C.
False
Hyperparathyroidism leads to increased bone resorption, resulting in hypercalcemia.
True
Osteoporosis commonly affects the proximal femur and proximal humerus.
True
Calcitonin is used in the treatment of osteoporosis to decrease osteoblastic activity.
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Renal rickets require the administration of low doses of active vitamin D.
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Genu varum is also known as knock knees.
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In infants, genu varum typically corrects itself by the age of 4 years.
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Treatment for genu valgum may include a supracondylar osteotomy of the femur if the condition does not improve by age 8.
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Coxa vara is characterized by a neck-shaft angle greater than 130°.
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Cubitus varus occurs when the carrying angle is below 10-15 degrees of valgus.
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Bone softening diseases can be caused by defective formation of osteoid.
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Osteoarthritis is a common cause of genu varum in adults.
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Cubitus valgus is corrected surgically through a wedge osteotomy at the elbow.
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Osteogenesis Imperfecta is characterized by defective collagen production which results in blue sclera.
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Vitamin D deficiency is a known cause of Osteogenesis Imperfecta.
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Rickets can be caused by insufficient sunlight exposure leading to inadequate vitamin D production.
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Infantile Rickets typically manifests after 3 years of age.
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The clinical feature of 'Pectus carinatum' is associated with Rickets.
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The Pigeon chest (pectus carinatum) is a common manifestation in Rickets.
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A characteristic sign of infantile rickets is delayed closure of fontanelles.
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Bone rarefaction is a finding that can be observed in X-rays of patients with Rickets.
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Study Notes
Orthopaedic Deformities
- Deformities are deviations from the normal appearance of a body part.
- Common deformities are either congenital or acquired.
- Most deformities may require surgical intervention.
Genu Varum (Bow Leg)
- In infants, genu varum is often developmental and usually resolves by age 4.
- In children aged 1.5-2 years, rickets is a common cause, and treatment focuses on addressing vitamin D deficiency.
- In adults, genu varum can be caused by osteoarthritis, mal-united fractures, ligamentous injury, and Paget's disease.
- Treatment in adults usually involves surgical correction of the deformity.
Genu Valgum (Knock Knees)
- Valgus knee up to the age of 4 years is often developmental and usually rectifies by age 6-8.
- If the condition persists, a supracondylar osteotomy of the femur might be necessary.
Coxa Vara and Coxa Valga
- The normal neck-shaft angle of the proximal femur is 160° at birth and decreases to 125° in adulthood.
- Coxa Vara: An angle less than 110° can lead to gait disability and spinal pain.
- Coxa Valga: An angle exceeding 130° can also lead to gait problems and spinal pain.
- Treatment involves corrective subtrochanteric osteotomy.
Cubitus Valgus and Cubitus Varus
- The normal carrying angle of the elbow is 10-15 degrees of valgus.
- Cubitus Valgus: An angle exceeding this range.
- Cubitus Varus: An angle below this range.
- Correction is achieved surgically through a wedge osteotomy at the lower humerus.
Bone Softening Diseases
- Bone is a connective tissue composed of cells and matrix.
- Osteoblasts are bone-forming cells.
- Osteoclasts are bone-resorbing cells.
- Osteoid is the bone matrix and is formed of collagen with deposited calcium salts.
- Bone softening diseases can arise from:
- Defective formation of osteoid (e.g., osteogenesis imperfecta)
- Defective mineralisation of osteoid (e.g., rickets)
- Increased bone resorption (e.g., hyperparathyroidism)
- Decreased bone formation (e.g., osteoporosis)
Osteogenesis Imperfecta
- It is a generalized mesenchymal disorder affecting bone and connective tissues.
- Characterized by:
- Defective osteoid production leading to fragile bone and frequent fractures.
- Defective collagen production causing joint hyperlaxity and blue sclera (eye whites).
- Types:
- Congenital: Stillbirth or multiple fractures at birth.
- Infantile: Manifestations develop early in infancy.
- Tarda: Manifestations occur later in childhood.
- Management focuses on preventing fractures, correcting deformities, and treating existing fractures.
Rickets
- It is a disease of growing bone with inadequate calcification of the bone matrix.
- Causes:
- Infantile: Vitamin D deficiency due to poor intake and lack of sunlight exposure.
- Celiac: Impaired fat and vitamin D absorption due to gluten intolerance.
- Renal: Disturbed calcium and phosphorus metabolism due to kidney dysfunction.
- Clinical Manifestations:
- Bony deformities like bow legs and knock knees.
- Characteristic signs of infantile rickets include:
- Boxy-bossy skull
- Rickety rosary (beading of the ribs)
- Pigeon chest
- Harrison Sulcus (a groove below the ribs)
- Broad metaphysis (end of long bones)
- Marfan sign (hyper-extensibility of joints)
- X-ray findings:
- Bone rarefaction (decreased density)
- Broadened and cupped metaphyses with "brush border" appearance
- Treatment:
- Infantile rickets: Diet rich in calcium, phosphorus, and vitamin D, sunlight exposure, and vitamin D supplementation.
- Renal rickets: High doses of active vitamin D (one alpha) and calcium.
- Surgical correction of severe deformities.
Hyperparathyroidism
- Primary hyperparathyroidism is characterized by excessive parathyroid hormone secretion due to parathyroid hyperplasia or tumor.
- This leads to:
- Increased bone resorption, causing hypercalcemia, renal calculi, cystic bone changes, deformities, and pathological fractures.
- Treatment involves surgical excision of the parathyroid adenoma.
Osteoporosis
- Diminished bone mass due to decreased bone formation with aging and menopause.
- Affected Sites:
- Vertebral column: Vertebral collapse leading to back pain, kyphosis, and wedged or biconcave vertebrae on x-ray.
- Proximal femur, proximal humerus, and distal radius, increasing fracture risk.
- Diagnosis is made using bone densitometry (DEXA).
- Treatment:
- Adequate diet with calcium, vitamin D, and protein.
- Daily exercises and sunlight exposure.
- Medications:
- Calcium, vitamin D
- Calcitonin (increases osteoblastic activity)
- Bisphosphonates (inhibit osteoclastic activity)
- Hormone Replacement Therapy (HRT) in some cases.
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Description
Explore the various orthopaedic deformities such as genu varum and genu valgum, including their causes and treatment options. This quiz will guide you through congenital and acquired deformities, detailing surgical interventions as necessary. Test your knowledge on these critical aspects of orthopaedic health.
