Delayed fracture union in a case of vitamin D dependent rickets associated with pulmonary tuberculosis - a case report

Authors

  • Neetin P. Mahajan Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India
  • Prasanna Kumar G.S. Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India
  • Tushar C. Patil Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India
  • Kevin A. Jain Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20213390

Keywords:

Rickets, Vitamin D, Pulmonary tuberculosis, Delayed fracture healing

Abstract

Rickets is a defect of bone mineralization caused by vitamin D deficiency, seen most significantly at growth plates that result in radiological bony abnormalities like metaphyseal flaring and cupping, physeal widening with focal and generalised osteomalacia. Here we present a rare case of 7 years old male, a case of vitamin D3 deficiency rickets in a known case of multi drug resistant pulmonary tuberculosis.  The patient had suffered left proximal fibular fracture following trivial fall 1.5 month back and had delayed bony union leading to difficulty in walking and pain. The patient was treated with oral vitamin D supplementation. In vitamin D deficiency rickets, there is decreased bone mineralization leading to weak bones and delayed fracture healing in children. Low serum vitamin D levels also caused decreased immunity with increased susceptibility to respiratory infections like pulmonary tuberculosis. Appropriate treatment with injectable or oral vitamin D3 with adequate exposure of sunlight and proper nutrition is the best modality of treatment.

 

Author Biography

Tushar C. Patil, Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India

Junior resident in the department of orthopaedics

References

Chapman T, Sugar N, Done S, Marasigan J, Wambold N, Feldman K. Fractures in infants and toddlers with rickets. Pediatric radiology. 2010;40(7):1184-9.

Elder CJ, Bishop NJ. Rickets. Lancet. 2014;383(9929):1665-76.

World Health Organization. Nutritional rickets: A review of disease burden, causes, diagnosis, prevention and treatment. Available at: https://www.who.int/publications/i/item/9789241516587.

Walker VP, Modlin RL. The vitamin D connection to pediatric infections and immune function. Pediatric research. 2009;65(7):106-13.

Fischer V, Haffner-Luntzer M, Prystaz K, Vom Scheidt A, Busse B, Schinke T et al. Calcium and vitamin-D deficiency marginally impairs fracture healing but aggravates posttraumatic bone loss in osteoporotic mice. Scientific rep. 2017;7(1):1-3.

Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Ped. 2004;50(6):364-8.

Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int j epidemiol. 2008;37(1):113-9.

Hayford FE, Dolman RC, Blaauw R, Nienaber A, Smuts CM, Malan L, Ricci C. The effects of anti-inflammatory agents as host-directed adjunct treatment of tuberculosis in humans: a systematic review and meta-analysis. Respiratory research. 2020 Dec;21(1):1-4.

Yeh JJ, Wang YC, Lin CC, Lin CL, Hsu WH. Association of respiratory tuberculosis with incident bone fracture: Bridging the tuberculosis airway infection and the osteoporotic bone. PloS one. 2016;11(12):e0168673.

Talat N, Perry S, Parsonnet J, Dawood G, Hussain R. Vitamin D deficiency and tuberculosis progression. Emerging infect diseases. 2010;16(5):853.

Downloads

Published

2021-08-25