D Deficiency – A Differential Diagnosis To Infant Fractures

Vitamin D deficiency rickets and allegations of non-accidental injury

Colin R Paterson

University of Dundee, Dundee, UK

Correspondence to Dr Colin R Paterson, Temple Oxgates, Longforgan, Dundee DD2 5HS, UK. Tel: +44 1382 360240 |

Email: c.s.paterson@btinternet.com

ABSTRACT

Vitamin D deficiency rickets has long been recognized as a cause of fractures and fracture-like appearances in young children. Often seen in the early 20th century, rickets has recently been regarded as uncommon; the radiological appearances, familiar to previous generations, may not be recognized for what they are.

This article reports four children with unexplained fractures initially attributed confidently to non-accidental injury. In each case, the later evidence of vitamin D deficiency led to a reconsideration of that diagnosis.

Conclusion:

It is important to be aware of this bone disorder in the differential diagnosis of fractures, to investigate appropriately and to recognize that the radiological appearances may be misleading. A mistaken diagnosis of abuse does real harm, not least to the child itself.

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Received 3 February 2009; revised 26 May 2009; accepted 3 June 2009.

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