Case contributed by Naim Qaqish
Diagnosis certain


Referred for low vitamin D3 and calcium levels.

Patient Data

Age: 1 year
Gender: Male

X-rays of the pelvis lower...


X-rays of the pelvis lower limbs & the Lt hand

Generalized decreased bone density, with poor mineralization of both femoral epiphyses, is noted.

Widening of the growth plate with metaphyseal cupping and fraying of all the lower limbs and left wrist bones.

Bilateral fracture lines involving the fibular diaphysis bilaterally.

Case Discussion

This is a 1-year-old boy referred with low calcium and vitamin D3 levels. An x-ray of the body was requested to look for signs of rickets. This demonstrated the classical abnormal configuration of metaphyseal "fraying", "cupping" and growth plate widening "splaying". Osteomalacia and bone fractures.

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