Results of surgical management of hypophosphatemic vitamin [D] resistant state

ABSTRACT

Hypophosphatemic rickets is the most common form of rickets seen in the developed communities. Intensive investigations recently had described several clinical forms of the disease in various age groups. This article presented the management results of six patients with hypophosphatemic vitamin D resistant rickets and osteomalacia. Two adolescents presented with bilateral lower limb deformities were treated with corrective osteotomies. Four adults presented with various pathological femoral fractures were managed by open reduction and internal fixation. The diagnosis was largely based on the typical biochemical profile which consistently showed hypophosphatemia with hypophosphatemia and reduced tubular re-absorption of phosphate. Other investigations were necessary to exclude similar forms of metabolic bone disease. Radiologically, non-specific ricketic changes in adolescents with looser zones in adults denoting metabolic nature of the disorder were seen in all cases. Increased bone density in axial skeleton with coarse widely spaced bone trabeculae in the pelvis were noted in adult males. All cases were started on combined regimen of vitamin D and oral phosphate supplement once the diagnosis was established. Apart from one incidence of delayed union in a pathologically fractured femur, all cases proceeded to union uneventfully