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Radiographic changes in nutritional ricket hips in children in response to treatment
1Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India.
Insights
Radiographic changes in children with nutritional rickets reveal distinct patterns of proximal femur growth plate activity. Understanding these age-dependent changes aids in comprehending hip deformities during rickets healing.
Area of Science:
- Pediatric Radiology
- Orthopedic Surgery
- Developmental Biology
Background:
- Nutritional rickets significantly impacts bone development in children.
- Proximal femur growth is crucial for hip joint formation and function.
- Radiographic assessment is key to monitoring treatment and understanding skeletal changes.
Purpose of the Study:
- To document sequential radiographic alterations in the proximal femurs of children undergoing treatment for nutritional rickets.
- To correlate these changes with the age of the child and the activity of specific growth plates.
- To establish a basis for understanding the pathomechanisms leading to hip deformities in rickets.
Main Methods:
- Retrospective review of pelvic radiographs from 161 children (≤13 years) with nutritional rickets.
- Analysis of growth plate activity (direction, area, contribution, structure) at serial follow-up intervals.
- Radiographic superimposition techniques were used for precise comparison.
Main Results:
- Proximal femur growth plates (longitudinal growth plate of the neck - LGP, femoral neck isthmus - FNI, trochanteric growth plate - TGP) show age-dependent differentiation and activity.
- Before age 1, growth zones are homogenous; by age 2, differentiation is evident.
- Distinct patterns emerge, including the 'eye sign' from LGP changes and medial overhang (MOH), with varying activity until age 12.
Conclusions:
- The mineralization process during rickets healing serves as a biological marker for growth patterns.
- Identifying the quantitative contribution of proximal femoral growth plates enhances understanding of hip deformity development.
- This knowledge can inform clinical management and potentially prevent long-term hip complications.
Purpose:
To review radiographic changes in the proximal femurs of children of different ages during the course of treatment for nutritional rickets.
Methods:
Pelvic radiographs of 161 children aged ≤ 13 years with nutritional rickets were retrospectively reviewed. Patients were treated with dietary counselling and vitamin D and calcium supplementation. Patients were followed up at week 3 and thereafter at a 2-month interval until ulnar convexity was achieved. Sequential radiographs of the hips in children of different ages were reviewed for each growth plate in terms of (1) the direction of growth, (2) active areas, (3) contribution of growth, and (4) the structure of the epiphysis. Radiographs were superimposed for comparison by matching the triradiate cartilage and the ischial portion of the obturator foramen.
Results:
The direction of growth of the growth plates was from the physeal plate that is the longitudinal growth plate of the neck (LGP), the femoral neck isthmus (FNI), and the trochanteric growth plate (TGP) to the diaphyseal region, and from the perichondrium to the ossification centre in the proximal femoral epiphysis. Before the age of one year, the growth zone of the proximal femur was homogenous, with no differentiation between the LGP, FNI, and TGP. By the age of 2 years, the differentiation was more clearly established; the FNI was usually smaller than the TGP and LGP. By the age of 3 years, the FNI became prominent and the TGP remained small. By the age of 4 years, the ossification centre of the greater trochanter appeared, and the LGP extended medially as a medial overhang (MOH). During the children's growth, the LGP, FNI, or TGP remained active to a variable extent and were distinct until the age of 6 years. Gradually, the periphery of the LGP became less active than the centre of the LGP and gave rise to the 'eye sign'. The MOH generally ceased to be active beyond the age 9 years. By the age of 12 years, the TGP and FNI were minimally active and only the centre of the LGP remained active.
Conclusion:
The mineralisation process of healing rickets provides a useful biological marker for patterns of growth. Knowledge of the quantitative contribution of various growth plates of the proximal femur in childhood may increase the understanding of the pathomechanism of hip deformations.
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