Nutritional rickets may be caused by deficiency of vitamin D and/or calcium. Thacher et al developed a grading scheme for the radiographic changes in joints associated with rickets. The score assesses the degree of metaphyseal fraying and cupping as well as the proportion of the growth plate affected. This can be used to initially determine the severity of disease and then to monitor response to treatment.
Radiographic examination: X-rays are taken of both wrists and both knees.
|
Bone |
Finding |
Grade |
|
radius |
normal |
0 |
|
|
widened growth plate, metaphyseal margin irregular, no concave cupping |
1 |
|
|
metaphyseal margin concave with fraying of margins |
2 |
|
ulna |
normal |
0 |
|
|
widened growth plate, metaphyseal margin irregular, no concave cupping |
1 |
|
|
metaphyseal margin concave with fraying of margins |
2 |
|
femur |
normal |
0 |
|
|
partial lucency; smooth margin of metaphysis visible |
1 |
|
|
partial lucency; smooth margin of metaphysis not visible |
2 |
|
|
complete lucency; epiphysis appears widely separated from distal metaphysis |
3 |
|
tibia |
normal |
0 |
|
|
partial lucency; smooth margin of metaphysis visible |
1 |
|
|
partial lucency; smooth margin of metaphysis not visible |
2 |
|
|
complete lucency; epiphysis appears widely separated from distal metaphysis |
3 |
|
Portion of Growth Plate Affected in Femur or Tibia |
Multiplier for Knee Score |
|
<= 1 condyle or plateau |
0.5 |
|
2 condyles or plateaus |
1.0 |
wrist score =
= (grade for radius) + (grade for ulna)
knee score =
= ((grade for femur) * (multiplier)) + ((grade for tibia) * (multiplier))
total score =
= (wrist score) + (knee score)
Interpretation:
• minimum scores: 0
• maximum wrist score: 4
• maximum knee score: 6
• maximum total score: 10
• The score changes with increments of 0.5.
• A score of 0 is normal.
• A score of 10 indicates severe disease.
Specialty: Nutrition, Endocrinology, Surgery, orthopedic
