Skip to main content
SpringerLink
Log in

Description and evaluation of operative deformity correction in calcium-deficiency rickets in Kaduna, northern Nigeria

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Rickets is a recurrent disease worldwide, especially in countries with limited resources (Nield et al Am Fam Physician 74(4):619–626, 2006; Thacher et al Ann Trop Paediatr 26(1):1–16, 2006). Medical therapy including orally administered calcium substitution is shown to improve a patients clinical symptoms and positively impact bone deformities, especially in the lower extremity. Even though orthopaedic intervention is necessary in a significant percentage of patients, few reports exist about operative deformity correction in patients wtih rickets.

Methods

We describe our concept of operative treatment by single-stage, three-dimensional closing-wedge osteotomies on 45 deformed legs in 27 patients from the rural area of Kaduna, North Nigeria, with calcium-deficiency rickets and evaluate the early results in a 1.5-year follow-up.

Results

We found a significant improvement in parameters of quality of life, functionality, clinical and radiological angulation and angles following the definition of Paley et al., with a complication rate of 4 % under 88 osteotomies (Paley et al Orthop Clin North Am 25(3):425–65, 1994).

Conclusion

The described operative therapy shows to be sufficient and with satisfactory results in correcting rickets-related leg deformities under rural circumstances with low availability of medical resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Emmert W-K (2008) Rachitis-ähnliche Symptome bei nigerianischen Kindern aus der Ethnie der Gbagyi in der südwestlichen Region Kadunas: Identifizierung des biochemischen Defekts, Sammeln von epidemiologischen Daten und Beschreibung des klinischen Bildes, aus Tropenmedizinischen Abteilung der Missionsärztlichen Klinik gGmbH. Bayerischen Julius-Maximilians-Universität: Würzburg

  2. Kitz C, Stich A, Ebert R, Jakob F, Raab PBS (2009) Rachitis in Nigeria—Spielen neben extremem Kalziummangel auch geologische und genetische Faktoren eine Rolle? Tropemed Flugmed Reisemed 16(2):76–80

    Article  Google Scholar 

  3. Paley D, Herzenberg JE, Tetsworth K, McKie JBhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25(3):425–65

    CAS  PubMed  Google Scholar 

  4. Nield LS, Mahajan P, Joshi AKamat D (2006) Rickets: not disease of the past. Am Fam Physician 74(4):619–626

    PubMed  Google Scholar 

  5. Thacher TD, Fischer PR, Strand MA, Pettifor JM (2006) Nutritional rickets around the world: causes and future directions. Ann Trop Paediatr 26(1):1–16

    Article  PubMed  Google Scholar 

  6. Oginni LM, Worsfold M, Oyelami OA, Sharp CA, Powell DE, Davie MW (1996) Etiology of rickets in nigerian children. J Pediatr 128(5 Pt 1):692–4

    Article  CAS  PubMed  Google Scholar 

  7. Pettifor JM (2004) Nutritional rickets: deficiency of vitamin D, calcium, or both? Am J Clin Nutr 80(6):1725S–1729

    CAS  PubMed  Google Scholar 

  8. Thacher TD, Fischer PR, Isichei CO, Pettifor JM (2006) Early response to vitamin D2 in children with calcium deficiency rickets. J Pediatr 149(6):840–4

    Article  CAS  PubMed  Google Scholar 

  9. Thacher TD, Fischer PR, Pettifor JM, Lawson JO, Isichei CO, Reading JC, Chan GM (1999) A comparison of calcium, vitamin D, or both for nutritional rickets in nigerian children. N Engl J Med 341(8):563–568

    Article  CAS  PubMed  Google Scholar 

  10. Song HR, Soma Raju VV, Kumar S, Lee SH, Suh SW, Kim JR, Hong JS (2006) Deformity correction by external fixation and/or intramedullary nailing in hypophosphatemic rickets. Acta Orthop 77(2):307–14

    Article  PubMed  Google Scholar 

  11. Rubinovitch M, Said SE, Glorieux FH, Cruess RL, Rogala E (1988) Principles and results of corrective lower limb osteotomies for patients with vitamin D-resistant hypophosphatemic rickets. Clin Orthop Relat Res 237:264–70

    PubMed  Google Scholar 

  12. Choi IH, Kim JK, Chung CY (2002) Deformity correction of knee and leg lengthening by Ilizarov method in hypophosphatemic rickets: outcomes and significance of serum phosphate level. J Pediatr Orthop 22(5):626–31

    PubMed  Google Scholar 

  13. Petje G, Meizer R, Radler C, Aigner NGrill F (2008) Deformity correction in children with hereditary hypophosphatemic rickets. Clin Orthop Relat Res 466(12):3078–85

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ekenze SO, Ikechukwu RN, Oparaocha DC (2006) Surgically correctable congenital anomalies: prospective analysis of management problems and outcome in a developing country. J Trop Pediatr 52(2):126–131

    Article  CAS  PubMed  Google Scholar 

  15. Craviari T, Pettifor JM, Thacher TD, Meisner C, Arnaud J, Fischer PR, Rickets Convergence G (2008) Rickets: an overview and future directions, with special reference to Bangladesh—A summary of the rickets convergence group meeting, Dhaka, 26–27 January 2006. J Health Popul Nutr 26(1):112–121

    PubMed  PubMed Central  Google Scholar 

  16. Kocaoglu M, Bilen FE, Sen C, Eralp LBalci HI (2011) Combined technique for the correction of lower-limb deformities resulting from metabolic bone disease. J Bone Joint Surg Br 93-B(1):52–56

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13596, Berlin, Germany

    Viktor Wesselsky

  2. Department of Orthopaedics, University of Wuerzburg, König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Germany

    Viktor Wesselsky, Franz Jakob, Jochen Eulert & Peter Raab

  3. Department of Tropical Medicine, Medical Mission Hospital, Salvatorstr. 7, 97074, Würzburg, Germany

    Christa Kitz

Authors
  1. Viktor Wesselsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christa Kitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Franz Jakob
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jochen Eulert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Raab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Viktor Wesselsky or Peter Raab.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wesselsky, V., Kitz, C., Jakob, F. et al. Description and evaluation of operative deformity correction in calcium-deficiency rickets in Kaduna, northern Nigeria. International Orthopaedics (SICOT) 40, 653–658 (2016). https://doi.org/10.1007/s00264-015-2911-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2911-7

Keywords

Search

Navigation