PMC3504259_01
Clinical photographs showing swelling of the right wrist (a) and left knee (b).
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fig1
On musculoskeletal examination, the child had swelling of wrist (Figure 1(a)) and knee joints (Figure 1(b)) bilaterally.
Anteroposterior (a) and lateral (b) X-rays of the knees showing varus deformity. Visible abnormalities include ground glass osteoporosis, thinning of the cortices, lucencies at metaphysis (Trummerfeld zone, black arrow), small corner fractures (Pelkan's spur, solid arrow), and dense zone of provisional calcification in the physis (White line of Frankel, dotted arrow).
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fig2
Anteroposterior (a) and lateral (b) X-rays of the hands and wrists showing severe osteopenia of the epiphyses of the phalanges (dotted arrow), metacarpals and the carpal bones, epiphyseal separation of the distal radius and ring sign (arrow).
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fig3
Follow-up X-rays of the knees (a) and wrist (b) at 6 weeks after initiation of vitamin C replacement therapy, showing improvement in osteopenia, healing of the epiphyseal fractures, and reduction in metaphyseal lucencies.
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fig4
Follow-up X-rays (Figures 4(a) and 4(b)) performed 6 weeks after initiation of treatment confirmed adequate response to the treatment as evidenced by improvement in osteopenia, healing of the epiphyseal fractures, and reduction in metaphyseal lucencies.