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Vol - 28, Issue - 09
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[This article belongs to Volume - 28, Issue - 09]
International Medical Journal
Journal ID
:
IMJ-28-09-2021-952
Total View
:
423
Title
:
Spontaneous bilateral femoral neck fracture in nutritional rickets
Abstract
: Amongst several Etiological causes of Rickets, one of the leading causes is Vitamin D and Calcium Deficiency. Vit D levels of our patient at presentation was 12.53 ng/ml, suggestive of nutritional deficiency of the same. (1) Patients with rickets are at increased risk for fractures (2). They commonly have bone pain and hyperalgesia that is poorly localized. The pain is most often located in the lower back, pelvis, and legs. The pain is worse at night, worse with weight-bearing, and worse with sudden movements, as was the case with our patient. Our management was aimed at correcting the nutritional deficiency along with surgically treating B/L fracture neck of femur. The operative procedure chosen should be similar to those recommended for the management of traumatic fractures of the neck of femur diagnosed late. These procedures should provide stable fixation of the fracture. In a young patient like ours, a decision was made to try and attempt to conserve the femur head by CRIF with three Austin Moore pins on each side. When Rickets develops due to 25(OH)D deficiency, treatment involves supplementation with cholecalciferol (D3) or ergocalciferol (D2). Symptoms of rickets may resolve rapidly with very small daily amounts, 800–1200 IU, of vitamin D3(4). The optimal target vitamin D is an area of controversy. The Institute of Medicine recommends targeting 25(OH)D levels >20 ng/mL for the for the general population. The AACE 2013 guidelines and the Endocrine Society 2011 guidelines recommend targeting 25(OH)D levels >30 ng/mL in bone disease.
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