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X-ray results

Is it possible for a new injury to show up on an xray looking like an old injury?

The doctors say it looks old and it must be from years ago but my daughter has never had any problems with her fibula before. (Although she did have a spiral fracture in her tibia twice)

She has had over 30 xrays in the last 18 monhts and there is nothing wrong with the fibula in any of them? Now the xray shows a salter harris fracture of fibula and malleolus.

Does it seem reasonable and likely that this did not show up on over 30 xrays??

Is there anything which will present as an old injury when it is actually a new one?
Thanks to anyone who can help!
36 Responses
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Avatar universal
Hi, Blayz just had a bone density scan. The results given to me were as follows:
The total body bone mineral density is calculated at 0.813 grams per centimeter squared which is 100% of the Z-score each matched value. The total bone mineral concentration is calculated at 921 grams and the bone mineral concentration per bone area is calculated at the 45th percentile in this child based on a lunar pediatric reference population.
Can you please tell me what this means?
Thank you!!
Helpful - 0
Avatar universal
Hi,
You need to understand when you are diagnosed with Osteogenesis Imperfecta you are bound to have fractures or bony deformities. In that case due to bony deformities or fractures alkaline phosphatase would be raised.
As bone turnover is more hence these bone turn over markers would be raised and these are excellent markers for monitoring.
No it is not considered a sign and symptom, but an association due to the pathology involved.
Exactly if she has fever the counts would have gone up high and the fever could have been due to viral fever.
Keep me informed if you have any queries.
You can visit the following URL for your reading.
http://www.orpha.net/data/patho/GB/uk-OI.pdf
Bye.
Helpful - 0
Avatar universal
Hi,
So it is normal for a person with O.I. to have high alkaline phosphatase levels then? Will it be this way her whole life? and is this considered a sign/symptom of O.I.? When she had the blood taken she was not sick that we were aware of. She had had a fever around about that time but nothing to concern us.
Thanks again!
Helpful - 0
Avatar universal
Hi,
How is your daughter doing?
High neutrophils suggest that she has contacted some infection, which can be either viral or bacterial.
High alkaline phosphatase is a part of her OI.
If neutrophils are high, lymphocytes would come down which again suggests that there is some infection which can be either bacterial or viral.
Does she have any fever? Does she have any coryza, cough of recent origin?
If yes then probably that would explain the condition and also the blood counts.
Keep me informed.
Bye.
Helpful - 0
Avatar universal
Hello once again,
Blayz recently had some blood work done:
Neutrophils levels came back High at 8.0 and 76.0
(Doctor suggested it should have been 1.2-6.0, and the other should have been 30-50)
Alkaline Phosphatase levels came back high also at 173
(Doctor suggested it should have been 37-113)
Lymphocytes came back at 1.7 and low at 16.1 (Doctor suggested the first is normal 1.0-5.5, but second measurment should have been 25-46, hers was 16.1)
What does any of this mean?? Does it have anything to do with her O.I. or is this completely unrelated?
Thank you in advance for any help you can be.
Helpful - 0
Avatar universal
Hi Pauline,
I remember that in one of my post I had mentioned regarding biphosphanates and you had replied saying what is it and nobody has even told you about it.
Pamidronate belongs to same class of drugs.
Diphosphonates treatment (Pamidronate, alendronate, etc.) may improve (but will not normalize) bone density, decrease fracture frequency, and improve quality of life in children but not adults
Molecular treatments are a goal for the future.
A physical therapist should be involved with most children to assess their abilities and plan realistic goals, working to develop ambulatory potential and proceeding with appropriate seating.
Keep me informed.
Bye.
Helpful - 0
Avatar universal
Hi,
We are waiting on an appointment with a pediatric geneticist who specializes in O.I. Blayz will be attending her O.I. appointments outwith our area, at a specialist teaching hospital. (University of North Carolina) They suggested she could have yearly I.V. treatments with pamidronate, but that was just a suggestion as yet, until we see the genetics specialist we won't know for definate what will be happening. The O.I. specialist has suggested my sisters 3 children be tested as they also have a history similar to that of my daughter, but so far have been diagnosed with hypermobility of the joints. I will keep you posted on the results of further testing.
Thanks again!
Helpful - 0
Avatar universal

Hi Pauline and Blayz,
How are you feeling now?
I am so glad and happy that our discussion and questions with each other has led to a confirmed diagnosis of your child. It deepens my confidence as a concerned clinician and a good paediatrician.
I would like to know what treatment management is being planned for her?
What about her investigations, have any results come?
Keep me informed if you have any queries.
Bye.
Helpful - 0
Avatar universal
Hello again,
My daughter has spent this week at the doctors office with both a pediatrician and an O.I. specialist. She has been diagnosed with O.I. plus dental. Thanks for all your help, answering all of my questions. Without your answers i would not have known which questions to ask. Asking questions is what led to my daughters confirmed diagnosis. Pauline and Blayz.
Helpful - 0
Avatar universal
Hi Blayz Moon,
What is your name Madam?
You can ask for DNA mutation analysis (blood test), which is available through specialized labs.
Dermal punch biopsy can be performed at a later stage to analyze collagen if routine diagnostic criteria are inconclusive.
Keep me informed.
Bye.
Helpful - 0
Avatar universal
Blayz sometimes appears to have difficulty hearing (Don't all young kids!) but she has not been tested as we had no reason to test her until now. Both her eyes have a blue tint to them. Her face is triangular in shape. She is not short for her age though. I myself have terrible teeth (what i have left anyway) despite always taking good care of them. I have only broken a few bones in my life though, nothing big. My husband has decent teeth and also has broken only a few bones. They mentioned something about the laxity of her achilles tendon on one of her notes a few months back. The dentist said he coulnd not believe the ortho doctors missed it, it was quite obvious she has blue eyes. (Not obvious to me of course, but obvious to a doctor) Her appoinment is on Friday morning. I will be asking for the genetic testing as well as the MRI. They will most likely try to pat me on the head and tell me to go home, like they always do (typical military - so used to dealing with soldiers they have lost all feeling for a small child) but this time i won't beleaving until they do as i ask. Will post the results of any testing when we get them. Thanks again.
Helpful - 0
Avatar universal
Hi, thanks for your comment. She is 6 years old. The dentist says osteogenesis imperfecta is a genetic disease and it can be given to the child by either parent but it can also be caused by a gene mutating by itself. It is usually carried from the parents but not always. She has an appoinment with Ortho on Friday so i will be requesting the testing including MRI. Thanks again!
Helpful - 0
Avatar universal
Hi Blayz Moon,
What is your name Sir?
Osteogenesis Imperfecta is a collagen disorder causing osseous fragility. This disease may affect bones, teeth, eyes, hearing, and soft tissue.
Is her height less as compared to her age?
Does she have any hearing deafness?
Does her face appear to be triangular in shape, like widened cranium and small, triangular faces?
A positive family history and signs such as abnormal dentition, blue sclerae, ligament laxity, scoliosis, or bone bowing/fragility are helpful in diagnosing the case.
When is her appointment with her surgeon?
Keep me informed.
Bye.
Helpful - 0
372680 tn?1228161610
I agree that she needs an MRI, hands down, and I just walked into this conversation.  I don't know what sort of history she has or how old she is, but I would try to get is taken care of as soon as possible since bodies heal better when younger; I myself could have been diagnosed with something when I was younger, but they never took an MRI (or even the correct x-rays) to see it -- that was a relatively new condition then, also.

Do you have other cases, that you know of, of osteogenesis imperfecta in your family?  I thought it was a genetic disease.
Helpful - 0
Avatar universal
Hello again,
Blayz had an appoinment today with her pediatric denitist to have her cavity filled and i asked him about there being a connection between her dental health and her history of fractures. He examined her and said the white of her eyes has a blue color to it, which indicates to him she may have a mild case of osteogenesis imperfecta +dental. She has an appointment on Friday with her ortho doctor and i will be asking for testing to get a definate diagnosis. Just thought we'd keep you up to date.
Thank again!
Helpful - 0
Avatar universal
Hi,
The alignment of a spiral fracture and oblique fracture is same and hence line of management remains same.
I feel what he meant by difference in fracture is Oblique fracture is of definite length, but spiral fracture is not and it also covers the girth of bone.
May be this is how he would have explained it to you.
What he has to say about the pathology behind her cavity in tooth and her decreased bone density.
How is Blayz doing? How did she celebrate her new year?
Keep me informed.
Bye.
Helpful - 0
Avatar universal
Hi again,
Nothing new going on, i just received the results from her last appointment with the pediatric orthopedician and it says in her notes he does not believe, from x-raying her legs that she ever had a spiral fracture in her tibia, rather, he believes it was a n oblique fracture. I have tried looking on the internet to find out the difference and how he could tell but have come up with nothing. Do you know the difference between spiral and oblique? and how he could tell? Thanks again!
Helpful - 0
Avatar universal
Hi,
I think you should be asking the details when you visit him next. You can also quiz him regarding the connection with bone health and tooth health.
Bye.
Helpful - 0
Avatar universal
Hi,
The dentist could not see it at all with the naked eye, even when he looked at her teeth following the xray to see if her could find any sign of it. He said he would be filling it using the xray to guide him to where it showed up on the tooth, he would not be filling it using sight because he can't see it. He did not say where it was located though, and i did not think to ask because i was in shock.
Thanks for your help.
Helpful - 0
Avatar universal
Hi,
I would like to know where the cavity present on the tooth is.
Is it in the crown portion or the root portion of the tooth as the crown portion is visible to you and the root portion is inside the jaw bone?
It is possible to have a cavity which might not be seen with naked eyes, but found on an x-ray.
If the cavity is in the root portion, then it may be related to her bone health.
If it is in the crown portion, it may be between two teeth which might not be visible from naked eye.
Helpful - 0
Avatar universal
Hi,
Yes, Dentists world wide think of decreased bone density whenever they find a cavity on oral examination. Dentists and dental hygienists aren't just looking for gum disease and cavities anymore. Bone health could be directly intertwined with the health of your jawbone, your teeth and even your gums.
Your answer regarding whether there is link between tooth having cavity and bone disease is yes there is a link.
In adults, if there is a cavity being found on dental x-ray, it suggests that the patient might have osteoporosis.
Similar profile if you extrapolate to kids health, suggests that they can have decreased bone density if they are found to have cavities in dental X-ray.
Have we done her Calcium, Vitamin D, Alkaline phosphatase and Vitamin D3 level for her?
I have asked to ask the orthopaedician regarding biphosphanates use in kids, this is the drug used to strengthen bone in kids.
Keep me informed about her disease progression.
Bye.
Helpful - 0
Avatar universal
Hi, sorry, no, nothing has changed with my daughter, she is fine. I was just speaking with my mother-in-law, and i was telling of all the findings with my daughter and i mentioned i had spoken to someone online about it all. She asked if the person i spoke with online was a doctor and i realised i had no idea if you were a doctor or not. I decided to ask, as you seemed very knowledgable, which is why it didn't occur to me to ask before. Blayz has a follow-up appointment to check on her fibula (only the fibula, she sees a different doctor for the assymetical growth etc.) on Jan. 11th. I would like to find a specific vitamin / mineral / herbal supplement for her to take - something which is specifically designed for bone and teeth strength. Do you know of such a supplement which is non-prescription? Although, when i take her on 11th i plan on asking about a prescription. I did have another question though. Can bone health and tooth health be linked? Her teeth have always been perfect, and at her latest cleaning / check-up the dentist said her teeth were still perfect, but then he gave her her first panoramic x-ray and discovered a tiny cavity in her first pre-molar, which only came through the gum in September. The dentist was shocked by this and said he would not have believed it possible with teeth like my daughters if he had not seen it on 2 different x-rays. Is it possible her cavity (which cannot be seen except on x-ray?) could be in any way linked to her bone strength etc. It seems unlikely to me that she could end up with a cavity when the tooth has only been in her mouth for a few months. I am obsessive about keeping her teeth healthy and clean. The shock from the dentist shows that. Could there be a link? or is that not possible? I did not mention any of the bone issues to her dentist mainly because i was in shock myself about the cavity. I should and would have asked him if i had been able to think clearly. Thanks again for your time and efforts. You are very helpful.
Helpful - 0
Avatar universal
Hi,
How are you? How is Blayz Moon?
I have changed my screen name. Yes, I am a doctor and for that matter a Pediatrician.
Why what is the concern and why are you worried all of a sudden?
How is your daughter, is she fine?
Helpful - 0
Avatar universal
Hi, sorry to bother you again. I was curious as to where you got all your expertise from? Are you a doctor? or a physicians assistant? or do you get your excellent and very helpful information from somewhere else? Thanks again!
Helpful - 0
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