Tratamiento ortopédico del raquitismo hipofosfatémico

Abstract

Hypophosphatemic rickets is a disease in the growing bone, before the fusion of the epiphysis. It is caused by vitamin D deficiency or low calcium intake. It can be caused by non- nutritional causes such as hypophosphatemic rickets and rickets due to renal tubular acidosis. Any disruption in the assembly, absorption, or metabolism of vitamin D has a significant influence on calcium metabolism and the development of rickets. The parents are used to consult after the second year of life due to presence of deformities on the lower limbs and growth retardation. The diagnosis is made based on the history, physical examination, laboratory tests. The x-rays can confirm the final diagnosis. The length of the lower limbs is more affected than the rest of the body. The body disproportion may be more noticeable during childhood and adolescence. Medical treatment at an early age has a positive impact on height. With a good follow-up the speed of growth increases and there may be an improvement in skeletal alterations. However, there is no compensatory growth secondary to onset growth retardation occurred before treatment. Surgical treatment is performed in patients with limb deformities and it will depend on some clinical aspects. When epiphyses are closed, the surgical correction should be performed with multiple osteotomies and external fixation with external tutors. Next, we present the case of a 19-year-old female patient with a history of hypophosphatemic rickets under treatment, who comes to the clinic due to lower extremity deformity and limitation for walking. Radiological exams show significant varus deformity of the lower extremities and closed epiphysis. After an adequate assessment, it was decided to correct them with osteotomies and fixation with external Ilizarov type tutors.