Anticonvulsant drug-induced rickets and multiple slipped epiphyses in a child treated non-operatively: a case report

The clinical and radiographic presentation of a child with spastic tetraplegia, anticonvulsant drug-induced rickets, borderline hypothyroidism and multiple slipped epiphyses is described. While the metabolic abnormalities were being treated, the parents denied surgical treatment and have been non-compliant with bracing of the wrist, ankle and knee deformities. By two years of medical treatment, rickets had resolved and the growth plates of the lower limbs' joints had closed. Non weight-bearing, gentle physiotherapy and bracing led to good results in the hip, ankle and wrist joints and to unacceptable residual valgus angular and rotational deformity of the right knee. Severely handicapped paediatric patients with metabolic bone disorders, non-compliant with bracing and with co-existent soft tissue contractures, are probably not good candidates for conservative treatment of severe angular limb deformities. However, non-operative treatment of minimal or moderate slippage of the proximal femoral epiphysis (as well as other major epiphyses) can lead to good results.