From the Department of Orthopedics, Kerala Institute of Medical Sciences, Anayara, Thiruvananthapuram, Kerala, India (Dr. Nazeer, Dr. Ravindran, and Dr. Katragadda); the Department of Orthopedics, Kasturba Medical College, Mangalore, Karnataka, India (Dr. E. N. Muhammed); the Department of Pediatrics, Kerala Institute of Medical Sciences, Anayara, Thiruvananthapuram, Kerala, India (Dr. Titus); and Kasturba Medical College, Manipal, Karnataka, India (Dr. M. N. Muhammed).
J Am Acad Orthop Surg Glob Res Rev. 2021 May 6;5(5):e21.00012. doi: 10.5435/JAAOSGlobal-D-21-00012.
Scurvy is rare in the present world and is mostly found in children with abnormal dietary habits and physical and mental disabilities. Scurvy can present in various forms, mimicking several common diseases, thus making the diagnosis difficult. Spontaneous epiphyseal separation is known to occur in scurvy, although rarely reported. The usual locations of these epiphyseal separations are distal femur and proximal humerus. Our case is unique in that scurvy in a seemingly normal child resulted in proximal femur epiphyseal separation which was not reported previously. We report a case of a 7-year-old boy presenting with pain and swelling in multiple joints for 6 months and later inability to walk. Pseudoparalytic frog-leg posture, dietary history of selective eating, and typical radiologic features made us consider a diagnosis of scurvy which was confirmed by a low serum vitamin C level. He developed epiphyseal separation of proximal femur and was treated with percutaneous screw fixation. Vitamin C supplementation resulted in prompt improvement clinically and radiologically.
坏血病在当今世界较为罕见,主要发生于饮食异常和存在精神或身体残疾的儿童中。坏血病可呈现多种形式,类似于几种常见疾病,从而导致诊断困难。已知坏血病会导致自发性骺分离,但罕有报道。这些骺分离通常发生于股骨远端和肱骨近端。我们的病例较为独特,看似正常的儿童发生了坏血病导致的股骨近端骺分离,这之前未有报道。我们报告了 1 例 7 岁男孩,6 个月来出现多个关节疼痛和肿胀,随后出现行走困难。假性瘫痪蛙腿姿势、选择性饮食的饮食史和典型的影像学特征使我们考虑坏血病的诊断,血清维生素 C 水平较低证实了这一诊断。他发生了股骨近端骺分离,采用经皮螺钉固定进行治疗。维生素 C 补充治疗后,患儿的临床和影像学结果迅速改善。