In osteomalacia, all the following seen except:
Correct Answer: Increased resistance to pathological fractures
Description: Ans: C (Increased resistance to pathological fractures) Ref: Apley's System of Orthopaedics and Fractures, 4th edition, pg. 137-8Explanation:OsteomalaciaThe classical lesion is the Looser zone, a thin transverse band of rarefaction in an otherwise normal-looking bone.These zones, seen especially in the shafts of long bones and the axillary edge of the scapula, are due to incomplete stress fractures which heal with callus lacking in calcium.More often, however, there is simply a slow fading of skeletal structure, resulting in biconcave vertebrae (from disc pressure), lateral indentation of the acetabula ('trefoil' pelvis) and spontaneous fractures of the ribs, pubic rami, femoral neck or the metaphyses above and below the knee.Features of secondary hyperparathyroidism characteristically appear in the middle phalanges of the fingers, and in severe cases so-called 1 brown tumours' are seen in the long bones.Biochemical changes common to almost all types of vitamin D related rickets and osteomalacia are diminished levels of serum calcium and phosphate, increased alkaline phosphatase and diminished urinary excretion of calcium.In vitamin D deficiency 25-OH D levels also are low.The calcium phosphate product, (derived by multiplying calcium and phosphorus levels expressed in mmol/L). normally about 3, is diminished in rickets and osteomalacia, and values of less than 2.4 are diagnostic.
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Orthopaedics
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