A 14-month-old child exclusively breastfed without vitamin D supplementation presents with bowing of legs, rachitic rosary, and hypocalcemic seizures. Biochemistry: serum calcium 7.2 mg/dL, phosphorus 2.1 mg/dL, ALP 890 IU/L, PTH elevated. Which radiological finding at the wrist is MOST specific for active rickets?
- A Increased bone density (sclerosis) at the metaphysis
- B Dense transverse bands (Looser zones) in the long bones
- C Cupping, fraying, and widening of the metaphysis with widened growth plate ✓
- D Periosteal elevation and new bone formation
Correct answer: C. Cupping, fraying, and widening of the metaphysis with widened growth plate
Explanation
In active rickets, the X-ray of the wrist (distal radius and ulna) shows cupping (concave/saucer-shaped metaphysis), fraying (irregular fuzzy metaphyseal margins), and widening of the metaphysis due to unmineralized osteoid accumulation at the growth plate. The growth plate appears widened. Sclerotic bands are not a feature of rickets. Looser zones are pseudofractures seen in osteomalacia in adults, not the primary finding in pediatric rickets. Periosteal elevation may occur with scurvy or osteomyelitis.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.