Infantile Scurvy

Age: 6–9 months (maternal vitamin C protects for first 6 months)

Predisposed: feeding with pasteurized / boiled milk

Pathogenesis: abnormal collagen formation

• irritability
• tenderness + weakness of lower limbs
• scorbutic rosary of ribs
• bleeding of gums ← teething
• legs drawn up + widely spread = pseudoparalysis

Location: distal femur (esp. medial side), proximal and distal tibia + fibula, distal radius + ulna, proximal humerus, sternal end of ribs

• “ground-glass” osteoporosis (CHARACTERISTIC)
• cortical thinning
• soft-tissue edema (rare)
• Metaphysis
  • white line = metaphyseal zone of preparatory calcification (DDx: lead / phosphorus poisoning, bismuth treatment, healing rickets)
  • Trümmerfeld zone = radiolucent zone on shaft side of Fränkel white line (site of subepiphyseal infraction)
  • Pelkan spurs = metaphyseal spurs projecting at right angles to shaft axis
    [Karl Francis Pel(i)kan (1890–????), University of California]
  • Park corner sign = subepiphyseal infraction / comminution resulting in mushrooming / cupping of epiphysis (DDx: syphilis, rickets)
    [E. Park, 1935, pathologist]
• Epiphysis
  • Wimberger ring = sclerotic ring around low-density epiphysis ← osteopenia of epiphysis
• Diaphysis
  • subperiosteal hematoma with calcification of elevated periosteum (sure sign of healing)
• Teeth
  • cyst formation + hemorrhage in enamel

DDx: TORCH infections, leukemia, neuroblastoma