SLR - April 2021 - Chengcheng Tu

Modern Day Scurvy in Pediatric Orthopaedics: A Forgotten Illness

Reference: Pan T, Hennrikus EF, Hennrikus WL. Modern Day Scurvy in Pediatric Orthopaedics: A Forgotten Illness. J Pediatr Orthop. 2021 Mar 1;41(3):e279-e284. doi: 10.1097/BPO.0000000000001731. PMID: 33528119.

Level of Evidence: Level IV

Scientific Literature Review

Reviewed By: Chengcheng Tu, DPM R
Program: New York Presbyterian Queens – Flushing, NY

Podiatric Relevance: Podiatric surgeons should have an increased awareness about the diagnosis of scurvy when a child presents with bone pain or the inability to walk. The goal of this study is to identify the common risk factors and the orthopaedic presentation of scurvy in children.

Methods: This is a retrospective chart and radiograph review study that included nine patients diagnosed with scurvy between 2010 to 2019 by the pediatric orthopaedic service. Data extracted for descriptive statistical analysis included: age, sex, neurological conditions, prematurity, psychiatric conditions, dietary abnormalities, bone pain, arthritis, limb swelling, inability to walk, skin changes, child abuse evaluations, radiographic findings, additional vitamin deficiencies, lab studies, additional tests, and response to treatment. 

Results: Seven males and two females were identified with an average age of seven. The average body mass index was 21.4 (range, 14 to 30). Five had autism, two had a neurological disorder, and two had a psychiatric disorder. Seven had an abnormal diet. Clinically, one presented with bone pain, four presented with limb swelling, five presented with inability to walk, and seven had unilateral and two had bilateral leg symptoms. Six were found with skin changes with ecchymosis or petechiae, and three with gingival bleeding. Radiographically, subperiosteal hematoma was noted in one, ring epiphysis in three, Pelkan spurs in one, metaphyseal white lines (Frankel sign) in six, and a metaphyseal zone of rarefaction (Trummerfeld zone) in three. Moreover, seven had additional vitamin deficiencies. The average erythrocyte sedimentation rate was 25.7 and C-reactive protein was 1.5. Given a vitamin C treatment lasting 3.4 months (range, two weeks to seven months), all children responded with symptoms gradually resolved and all children were able to walk.

Conclusions: In this study, we found that the most common orthopaedic presentation was the refusal to bear weight and the most common radiographic finding was the Frankel sign. Vitamin C supplementation achieved excellent results in all cases. 

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