Metabolic Disorders

Deficiency in the shape, strength, and structure of bone tissue due to altered bone mineral homeostasis is called metabolic bone disease. The major factors affecting this homeostasis are intracellular and extracellular levels of calcium, phosphorus, and magnesium, controlled by parathyroid hormone, calcitonin, and 1, 25-dihydroxyvitamin D, which act on the bone, gut, and kidney. Common manifestations of the metabolic bone disease include electrolyte disturbances, fractures, skeletal deformity, abnormal gait, and short stature, requiring orthopedic referral. The most commonly encountered forms of metabolic bone disease in children are the several types of rickets and renal osteodystrophy. Milder deformities are managed by medical treatment of the metabolic defect(s) and bracing and guided growth treatment. However, often such deformities tend to be multiapical and require multilevel osteotomies that are stabilized with external fixation and/or internal fixation. All patients should be metabolically optimized prior to surgery and require close follow-up. In addition, as these deformities tend to recur after surgery, intramedullary fixation should be strongly considered whenever and wherever possible.