Case Of the Week (COW) 07 July 2013
Answer:
Multiple Spontaneous “Pseudo-fractures” of Bone (Milkman's Syndrome)
Findings:
Multiple bilateral symmetric transverse pseudofractures noted in both ischiopubic rami , superior and inferior pubic rami , 11th and 12th ribs . Pseudofractures are also noted in right ilium and left femoral neck. Erosions with widening of both sacroiliac joints noted , reflecting sacroilitis These multiple pseudo fractures are the hall mark of Vitamin D Deficiency –Osteomalacia. Laboratory examinations revealed barely detected Vitamin D levels.
Discussion:
Osteomalacia is a metabolic disease of bone in which there is a deficient mineralization of the bony matrix. Multiple, almost symmetrical, radiolucent bands of diminished density, resembling fractures, occur in the cortex of the bone. These pseudofractures are seen most frequently in the axillary border of the scapula, the ribs, the pubic rami, the medial aspect of the neck of the femur, the iliac bones, and the radii and ulnae. They were first described by Milkman and hence known as “Milkman's syndrome” Pseudofractures in many diseases other than osteomalacia, like osteogenesis imperfecta,, hyperparathyroidism, hyperthyroidism, Paget's disease, adrenal-pituitary bone dystrophy, severe chronic acidosis or hyperglycemia, congenital syphilis, osteomyelitis and osteopetrosis They differ in the following respects: they usually are not bilaterally symmetrical; there are no definite sites of predilection; they heal rapidly without therapeutic measures to increase the body stores of calcium and phosphorus; and they usually are present in areas of localized bone disease or as a result of trauma
Ref:A Mechanism of the Production of Pseudofractures in Osteomalacia (Milkman's Syndrome) March 1954 Radiology, 62,388-395.
Answer:
Multiple Spontaneous “Pseudo-fractures” of Bone (Milkman's Syndrome)
Findings:
Multiple bilateral symmetric transverse pseudofractures noted in both ischiopubic rami , superior and inferior pubic rami , 11th and 12th ribs . Pseudofractures are also noted in right ilium and left femoral neck. Erosions with widening of both sacroiliac joints noted , reflecting sacroilitis These multiple pseudo fractures are the hall mark of Vitamin D Deficiency –Osteomalacia. Laboratory examinations revealed barely detected Vitamin D levels.
Discussion:
Osteomalacia is a metabolic disease of bone in which there is a deficient mineralization of the bony matrix. Multiple, almost symmetrical, radiolucent bands of diminished density, resembling fractures, occur in the cortex of the bone. These pseudofractures are seen most frequently in the axillary border of the scapula, the ribs, the pubic rami, the medial aspect of the neck of the femur, the iliac bones, and the radii and ulnae. They were first described by Milkman and hence known as “Milkman's syndrome” Pseudofractures in many diseases other than osteomalacia, like osteogenesis imperfecta,, hyperparathyroidism, hyperthyroidism, Paget's disease, adrenal-pituitary bone dystrophy, severe chronic acidosis or hyperglycemia, congenital syphilis, osteomyelitis and osteopetrosis They differ in the following respects: they usually are not bilaterally symmetrical; there are no definite sites of predilection; they heal rapidly without therapeutic measures to increase the body stores of calcium and phosphorus; and they usually are present in areas of localized bone disease or as a result of trauma
Ref:A Mechanism of the Production of Pseudofractures in Osteomalacia (Milkman's Syndrome) March 1954 Radiology, 62,388-395.