Clinical_Rounds_in_Endocrinology_Volume_II_-_Pediatric_Endocrinology

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40. How to examine for genu valgum and genu varum?

Genu varum is determined by the measurement of intercondylar distance.

Examination can be performed in sitting or supine posture with both the

lower limbs kept in straight position. Patient is asked to approximate the

malleoli, and intercondylar distance is measured thereafter with a metallic

tape. A distance of >5–6 cm is suggestive of genu varum. Genu valgum is

determined by the measurement of intermalleolar distance. Examination can

be performed in the same position as for genu varum. Patient is asked to

approximate the femoral condyles and intermalleolar distance is measured

with a metallic tape. A distance of >8–10 cm is suggestive of genu valgum.

41. What are the radiological manifestations of rickets?

Rickets is a metabolic bone disease that involves epiphysis, physis (growth

plate), metaphysis, and diaphysis.

Site Features

Epiphysis Irregular margins

Physis Widening along longitudinal axis

Metaphysis Fraying, cupping, splaying

Coarse trabecular pattern

Diaphysis Osteopenia, cortical thinning,

Looser’s zone

The other radiological findings include deformities in the extremities (e.g.,

bowing), rachitic rosary, slipped capital femoral epiphysis, triradiate pelvis,

and wormian bones (Fig. 5.10).

Active rickets

Cupping with fraying

Metaphysis Widening

Epiphysis

Fig. 5.10 Diagrammatic illustration of metaphyseal changes in rickets

5 Rickets–Osteomalacia