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Rickets - active

Case contributed by Mohamed El Deen
Diagnosis almost certain

Presentation

Bowing of lower limbs, delayed walking, hypotonia and pallor.

Patient Data

Age: 1 year
Gender: Male
x-ray

Both hands AP view demonstrating bilateral cupping and fraying of the metaphyseal regions of both bones with widening of the wrist joint space.

x-ray

The cupping and fraying of the distal radius and ulna is amazingly illustrated.

Case Discussion

In rickets there is defective mineralization of growth plates of long bones, resulting in growth retardation and delayed skeletal development. The distal radius and ulna are typically affected in active rickets.

Findings suggesting active rickets are fraying, cupping of the metaphysis, and widening of the joint space.

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