Looser's zones (Milkman's fractures) in osteomalacia are linear radiolucent zones that occur perpendicular to the cortex. They are characteristically found at which anatomical sites?

• A Vertebral body end-plates, metaphyses of long bones, metacarpal shafts
• B Medial femoral neck, medial margin of the scapula, superior pubic rami, ribs, metatarsals ✓
• C Greater trochanter, calcaneal cortex, posterior ilium
• D Lateral femoral condyle, lateral tibial plateau, distal fibula

Explanation

Looser's zones are pseudofractures — incomplete stress fractures through undermineralized bone filled with fibrous tissue and callus. They are characteristically bilateral and symmetric, occurring at areas of maximal mechanical stress or vascular penetration: medial femoral neck, medial margin of the scapula (axillary border), superior and inferior pubic rami, proximal ulna, ribs (lateral aspect), and metatarsals. These sites correspond to where the periosteal nutrient arteries penetrate the cortex. Recognition of their distribution is key to distinguishing osteomalacia from pathological fractures or Paget's disease.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.