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1. Normal growth plate

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Figure 59-1

Normal growth plate.

A-C. Wrist radiographs of 3 different children, aged 1 month

(A), 17 months (B), and 13 years (C). The zone of provisional calcification is a thin dense band that caps the metaphysis. This band is only faintly dense compared with the metaphysis in "A." It is thin and well defined in "C." The spongy bone in the metaphyses has a lacy character.

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2. Vitamin D deficiency rickets

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Figure 59-2

Vitamin D deficiency rickets.

A wrist radiograph of a 15-month-old infant shows poor definition of the zone of provisional calcification in the metaphyses of the radius and ulna. There is mild metaphyseal cupping of the ulna.

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3. Rickets

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Figure 59-3

Rickets.

A-E. Radiographic manifestations of vitamin D deficiency in 5 different children. There is widening of the growth plates (although part of the lucency is due to deficient mineralization of the metaphyses). The metaphyses are irregular, wide, and variably cupped. There is poor definition of the epiphyses in "B." Note periosteal new bone formation along the metacarpal shafts in "D."

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4. Rickets

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Figure 59-4

Rickets.

Growth plate widening and metaphyseal cupping are present in this 11-month-old child. There is mild generalized osteopenia. The trabecular pattern is coarse. There is a pathological fracture in the femur.

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5. Rickets

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Figure 59-5

Rickets.

This 2-year-old child suffered severe nutritional deprivation. There is severe osteopenia. The trabecular pattern is coarse. Deficient physeal and metaphyseal mineralization results in apparent widening of the growth plates. A Looser zone (arrow) is present in the tibia. There is also a faint linear lucency in the bowed fibula. Poorly mineralized subperiosteal osteoid extends along the bone shafts.

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6. Rickets

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Figure 59-6

Rickets.

There is poor mineralization of the ribs and scapula of this 15-month-old child with nutritional rickets. Enlargement of the rib ends (arrows) and the adjacent nonmineralized cartilage cause the palpable "rachitic rosary."

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7. Rickets

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Figure 59-7

Rickets.

A lateral radiograph of a 2-year-old child with severe nutritional rickets shows markedly deficient mineralization of the teeth and lamina dura.

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