Abstract
We performed correction for bowing deformity of the lower extremities due to vitamin D-resistant hypophosphatemic rickets of three adults, six segments. The operative method was gradual correction and lengthening using distraction osteogenesis by Ilizarov external fixator or Heidelberg external fixator. The orders of the corrections were simultaneous correction of the bilateral femur for one patient, simultaneous correction of the ipsilateral leg for one patient, and diagonal correction of the bilateral leg for one patient. The mean correction angle was 30.5°. The mean external fixation period was 146 days. Each orders of the corrections had its merits and demerits. All patients obtained a physiological alignment and good bone formation by taking Vitamin D and oral phosphate supplements even an adult patient. All the patients had articular pain, such as hip, knee, and ankle, however, these pains healed up. All the patients were satisfied with the outcomes at the time of the final follow-up interview in terms of their cosmetic improvement. Distraction osteogenesis for bowing deformity of the lower extremities due to vitamin D-resistant hypophosphatemic rickets was very effective method and could be applied to adult patients. However, the order of the corrections should be considered carefully depending on each patient.
Similar content being viewed by others
References
Albright F, Butler AM, Bloomberg E (1937) Rickets resistant to vitamin D therapy. Am J Dis Child 54:529–547
Arnstein AR, Frame B (1966) Primary hypophosphatemic rickets and osteomalacia; a review. Clin Orthop Relat Res 49:109–118
Barbour BH, Kronfield SJ, Pawlicki A (1964) On the mechanism of tubular reabsorption of phosphorous in vitamin D resistant rickets. Clin Res 12:247
Choi IH, Kim JK, Chung CY, Cho TJ, Lee SH, Suh SW, Whang KS, Park HW, Song KS (2002) Deformity correction of knee and leg lengthening by Ilizarov method in hypophosphatemic rickets; outcomes and significance of serum phosphate level. J Pediatr Orthop 22:626–631
Eguchi M, Kaibara N (1980) Treatment of hypophosphataemic vitamin D-resistant rickets and adult presenting hypophosphataemic vitamin D-resistant osteomalacia. Int Orthop 3:257–264
Evans GA, Arulanantham K, Gage JR (1980) Primary hypophosphatemic rickets. Effect of oral phosphate and vitamin D on growth and surgical treatment. J Bone Joint Surg Am 62:1130–1138
Eyres KS, Brown J, Douglas DL (1998) Osteotomy and intramedullary nailing for the correction of progressive deformity in vitamin D-resistant hypophosphataemic rickets. J R Coll Surg Edinb 38:50–54
Ferris B, Walker C, Jackson A, Kirwan E (1991) The orthopaedic management of hypophosphataemic rickets. J Pediatr Orthop 11:367–373
Glorieux FH, Marie PJ, Pettifor JM, Delvin EE (1980) Bone response to phosphate salts, ergocalciferol, and calcitriol in hypophosphatemic vitamin D-resistant rickets. N Engl J Med 303:1023–1031
Kanel JS, Price CT (1995) Unilateral external fixation for corrective osteotomies in patients with hypophosphatemic rickets. J Pediatr Orthop 15:232–235
McAlister WH, Kim GS, Whyte MP (1987) Tibial bowing exacerbated by partial premature epiphyseal closure in sex-linked hypophosphatemic rickets. Radiology 162:461–463
Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–265
Rasmussen H, Anast C, Parks J, Haussler M, Lane J, Pechet M (1976) 1-α(OH)D3 in treatment of hypophosphatemic rickets. Clin Res 23:486a
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 237:264–270
Sofield HA, Miller GA (1959) Fragmentation re-alignment and intramedullary rod fixation of deformities of long bones in children. J Bone Joint Surg Am 41:1371–1391
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matsubara, H., Tsuchiya, H., Kabata, T. et al. Deformity correction for vitamin D-resistant hypophosphatemic rickets of adults. Arch Orthop Trauma Surg 128, 1137–1143 (2008). https://doi.org/10.1007/s00402-007-0548-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-007-0548-8