Module 66, Pediatric Orthopaedist Level

A 2 year and 6 month old girl was recently adopted and brought for a medical evaluation. The available history was that the child was born to a mother who suffered from alcohol abuse. She was born prematurely (gestational age not available) at 2000 gms, 44 cm, with an apgar of 5/6. Furthermore, she had previously been diagnosed with encephalopathy, anemia, fetal alcohol syndrome and rickets. The adopted mother states that the child began walking recently at the age of 27 months. Laboratory tests included: Ca: 9.7(normal), Phosphorus 6.2(mildly increased), Alk Phos: 401(mildly increased) and Vit D 1 25: 92( mildly increased). She was diagnosed with nutritional rickets and was treated with Calciferol 1200 ug \ day.

Question 66A

You inform the adopted mother that she should expect to wait approximately six months until a change in the child's condition is noted.

Question 66B

You would plan to do tibial osteotomies to correct the severe varus deformities in approximately 1 year after a good response the nutritional management is seen.

Question 66C

It is important to carefully monitor this girl's spine for kyphosis and to a get a dental evaluation.

Question 66D

On further testing the child was found to have elevated serum, BUN and creatinine. It is now likely that all these changes are due to chronic renal failure.

Question 66E

Rickets always causes knee varus deformities.