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Joseph Junewick, MD FACR
over 11 years ago
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Insufficiency Fracture, Rickets of Prematurity

Case Detail

Anatomy: Musculoskeletal
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: CR US
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4 month old former 24 week premature infant with respiratory distress.

Case Images


Insufficiency Fracture, Rickets of Prematurity


CR – Collar of periosteal new bone at the level of the right proximal humeral physis.

US – Periosteal new bone is not as echodense as cortex and is discretely visible. No joint effusion, pannus or chondrolysis.


More than 80% of fetal bone mass is achieved during the 3rd trimester. Rickets of prematurity is seen in infants less than 28 weeks gestation and less than 1000 grams; breast milk and formula do not supply adequated calcium and phosphorus to support normal bone health. Total parenteral nutrition may contribute to metabolic bone disease.

Radiographic findings include osteopenia and fractures. Rib fractures may impair breathing in patients who are already respiratorily compromised. Typically rachitic changes of the metaphyses of the long bones will not be seen until the infants overcome the stresses of prematurity and begin to grow.

Sonography may be helpful in establishing the diagnosis of fracture before there are radiographic signs and in differentiating from osteomyelitis .


Shore RM. Metabolic Bone Disease. Caffey’s Pediatric Diagnostic Imaging, 11th Ed. Mosby-Elsevier (2008).

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