Alkaline phosphatase as a screening test for osteomalacia

Vitamin D deficiency remains common in children and adults in Pakistan despite adequate sunlight exposure. Diagnosis in adults is usually delayed and is made following pathological fractures that result in significant morbidity. The objective of this study was to see whether Serum Alkaline Phosphatase levels could be used as a screening test for osteomalacia. The Study was conducted at Fatima Hospital, Baqai Medical University, Gadap, Karachi, between July 2002 and June 2005. Serum calcium levels are commonly used to screen patients suspected of osteomalacia, and raised serum alkaline phosphatase [SALP] is considered a diagnostic finding. We used SALP to screen patients who presented with back or non-specific aches and pain of more than six months duration. Three hundred thirty-four [334] patients were screened of which 116 [35%] had raised SALP. Osteomalacia was diagnosed in 92 [79.3%] of these 116 either by plain radiographs, bone biopsy or isotope bone scan. Fifty-four [53.4%] of the 101 cases had a normal level of serum calcium. Osteomalacia is likely to be missed if only serum calcium is used to screen patients. Serum Alkaline Phosphate should be used as the preferred method for screening these patients

Soak the cast off

Plaster of Paris cast is still the most common form of external splintage used in orthopaedics. It is usually removed by cutting it with an electric oscillating saw. The noise created by this instrument and the sight of the blade can both be frightening, particularly for young children. As Plaster of Paris gets soft with water, soaking it to remove plaster in children is a good option, particularly neonates treated by serial casting for clubfeet. Our experience with this method was very encouraging. There were no failures. Most patients or parents of neonates were satisfied and happy to remove the plaster at home. Average time taken to remove the plaster was 25 minutes