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Scurvy (Vit-C Deficiency)

  1. Vit C is necessary for hydroxylation of lysine and proline to hydroxylysine and hydroxyproline, two aminoacids crucial for proper cross linking of triple helix of collagen. So deficiency causes failure of collagen synthesis or primitive collagen formation, throughout the body, including in blood vessels, predisposing to haemorrhage.
  2. Dysfunctional osteoblast (flat resembling fibroblast) causes failure of osteoid formation resulting in generalized osteoporosis
  3. Chondroblast & mineralization is unaffected causing persistence of calcified cartilage approaching metaphysis seen radiologiclly as opaque white line at junction of physis and metaphysis (Frankel’s line)
  4. Osteoclasts are normal causing thin and fragile trabeculae and cortices of bone.
  5. Dentine formation in teeth is abnormal.
Clinical Feature
  1. It develops after 6 - 12 months of dietary deprivation. For this reason it is not seen in neonates.
  2. Earliest features are restlessness, fretfullness, irritability, loss of appetite and failure to thrive
  3. Gums may be spongy and bleed.
  1. Subperiosteal haemorrhage is a distinct sign occuring most commonly in distal femur & tibia and proximal humerus, causing excruciating, pain near the large joints. The child lies still to minimize pain or minimally move the affected limb (Pseudoparalysis)s
  2. Haemorrhage in soft tissue, joint, kidney, gut and petechiae may be seen
  3. Anemia & impaired wound healing is seen.
  4. Beading of ribs at costochondral junction is seen
  5. Systemic reaction (fever) is absent initially.
Radiological Feature
  1. Osteopenia (1st sign) with thinning of cortex, most marked in the long bone metaphysis.
  2. Metaphysis may be deformed or fractured.
  3. Frankel’s line (zone of provisional calcification increases in width & opacity)
  4. Scurvy line or scorbutic zone is radiolucent transverse band adjacent to the dense provisional zone.
  5. Margins of the epiphysis appears relatively sclerotic, termed ringing of epiphyses or wimberger’s sign (Ring sign)
  6. Lateral metaphyseal spur at ends of metaphysis is produced by outward projection of zone of provisional calcification.
  7. Corner or angle sign is peripheral metaphyseal cleft
  8. Subperiosteal haemorrhagee

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