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Surgical Indications in Hypophosphataemic Rickets
1Jefa de Sección de Traumatología Infantil, Departamento de Traumatología y Cirugía Ortopédica Infantil, Hospital Universitario de Getafe, Getafe, Madrid, Spain. anabuenosanchez@hotmail.com.
Insights
Hypophosphatemic rickets, caused by low blood phosphate, leads to bone deformities and fragility. Surgical interventions, ranging from guided growth to osteotomies, are considered for severe cases.
Area of Science:
- Pediatric Endocrinology
- Orthopedic Surgery
- Nephrology
Background:
- Hypophosphatemic rickets results from impaired renal phosphate reabsorption, leading to low blood phosphate levels.
- This condition causes significant bone metabolism alterations, including increased osteoclast activity, leading to bone deformities, fragility, and impaired growth.
- Manifestations include delayed growth, bone pain, microfractures, and frequent fractures.
Purpose of the Study:
- To review surgical indications for managing hypophosphatemic rickets.
- To highlight the spectrum of surgical approaches, from conservative to aggressive, for bone deformities and osteomalacia.
Main Methods:
- Review of current literature and clinical practices regarding surgical management of hypophosphatemic rickets.
- Categorization of surgical techniques based on deformity severity and patient age.
Main Results:
- Conservative management is often sufficient, but surgical intervention is indicated for significant bone deformities or severe osteomalacia.
- Surgical options range from minimally invasive guided growth techniques for less severe deformities to corrective osteotomies for complex, three-dimensional deformities.
Conclusions:
- Surgical intervention plays a crucial role in correcting deformities and improving outcomes in patients with hypophosphatemic rickets.
- A tailored approach, considering both aggressive and non-aggressive surgical strategies, is essential for optimal patient care.
Abstract:
Low levels of phosphate in blood secondary to a lack of phosphorous reabsorption in the renal tubule cause hypophosphataemic rickets. To increase blood calcium levels, bone calcium is released into the bloodstream by increasing the activity of osteoclasts in the bones. These alterations in bone metabolism lead to delayed growth and small height, diffuse bone pain, bone fragility with microfractures, and frequent fractures and bone deformities. Although management of some of these conditions is mainly conservative, in cases of bone deformities or severe osteomalacia surgery should be considered: from minimally invasive surgical techniques of guided growth in patients with less deformity and open physeal cartilage to correction osteotomies in three-dimensional deformities. This article briefly reviews the indications for surgery procedures to be performed in these patients, highlighting when to use aggressive and non-aggressive approaches.
