All of the following are seen in rickets except:September 2009

Ans. A: Frenkels LineIn rickets, the skeletal effects are due to lack of calcification of osteoid.The first changes of rickets appear in rapidly growing distal ends of ulna & radius (wrist & knee are commonly involved due to more use).Rarefaction of provisional zone of calcification with widening of epiphysis- diaphysis distance is first to appear. The most obvious change are at 'metaphysis'- where rapid growth is occurring.First change to appear is a 'loss of normal zone of provisional calcification' adjacent to metaphysis.This begins as an indistinctness of the metaphyseal margin, progressing to a 'frayed' appearance with widening of the growth plate, due to lack of calcification of metaphyseal bone.Weight bearing & stress on uncalcified bone gives rise to 'splaying' Sr 'cupping' of metaphysis.A similar but less marked effect occurs in subperiosteal layer, which may cause lack of distinctness of coical margin.Eventually a generalized reduction in bone density is seen.In the epiphysis - there may be some haziness of coical margin.Thus all findings in Rickets occur due to failure of calcification & abnormal demineralizationi. Skull changes- Pronounced calvarial demineralization- Basilar Invagination- Indistinct sutural margin- Delayed tooth eruption Premature craniostenosis- Craniotabes- Calvarial thickening following treatmentii. Spine changes- Scoliosis- Biconcave veebral bodies- Triradiatic pelvis.