Paediatric leg

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=100 BGCOLOR="#000000" TEXT="#F7F7FF" bgproperties="fixed" background="03f00640dvldtc.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>Radiographers Reporting</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="Radiographers Reporting"><U><B>home</B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="The Report"><U>The Report</U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Shoulder"><U>Shoulder</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="Elbow"><U>Elbow</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="Wrist"><U>Wrist</U></A>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Hand"><U>Hand</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Pelvis/Hip"><U>Pelvis/Hip</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="Knee"><U>Knee</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="Ankle"><U>Ankle</U></A>   |   <A HREF="id26.htm" TARGET="_top" TITLE="Foot"><U>Foot</U></A>   |   <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris fractures</U></A>   |   <A HREF="id33.htm" TARGET="_top" TITLE="Paediatric arm."><U>Paediatric arm.</U></A>   |   <B>Paediatric leg</B>   |   <A HREF="id29.htm" TARGET="_top" TITLE="Should you include the Radiologist?"><U>Should you include the Radiologist?</U></A>   |   <A HREF="id31.htm" TARGET="_top" TITLE="Guest book and link sites."><U>Guest book and link sites.</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#000000" TEXT="#F7F7FF" background="040d2c00dvldtc.gif"> <div> <B>1.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="0e7b30b0.jpg" border=0 width="179" height="267" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>2.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="0e9b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>3.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="3b4b4630.jpg" border=0 width="180" height="355" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>4.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="09db9140.jpg" border=0 width="185" height="276" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>5.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="0a2b50e0.jpg" border=0 width="181" height="270" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>6.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="0a1b8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>7.</B></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="3b6b4800.jpg" border=0 width="180" height="384" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>8.</B></div> <div> <B><IMG SRC="3deb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>9.</B></div> <div> <B><IMG SRC="3e0b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>10.</B></div> <div> <A HREF="#image_10" TITLE="Paediatric leg"><U><B><IMG SRC="3e2b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A></div> <div> <B>10.</B><B> <A NAME="image_10"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="3e4b4cd0.jpg" border=0 width="180" height="205" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>11.</B></div> <div> <B><IMG SRC="2f9b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>12.</B></div> <div> <B><IMG SRC="40bb4b70.jpg" border=0 width="180" height="183" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>13.</B></div> <div> <B><IMG SRC="3a6b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>14.</B></div> <div> <B><IMG SRC="3a8b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>15.</B></div> <div> <B><IMG SRC="3aab40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>16.</B></div> <div> <B><IMG SRC="41ab4ca0.jpg" border=0 width="180" height="202" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>17.</B></div> <div> <B><IMG SRC="230b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>18.</B></div> <div> <B><IMG SRC="22eb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>19.</B></div> <div> <B><IMG SRC="232b48d0.jpg" border=0 width="180" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>20.</B></div> <div> <B><IMG SRC="3c0b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>21.</B></div> <div> <B><IMG SRC="43ab4930.jpg" border=0 width="180" height="147" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>22.</B></div> <div> <B><IMG SRC="234b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>23.</B></div> <div> <B><IMG SRC="3e6b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>24.</B></div> <div> <B><IMG SRC="236b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>25.</B></div> <div> <B><IMG SRC="238b4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>26.</B></div> <div> <B><IMG SRC="23ab4790.jpg" border=0 width="180" height="121" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>27.</B></div> <div> <B><IMG SRC="422b4980.jpg" border=0 width="180" height="152" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>28.</B></div> <div> <B><IMG SRC="23cb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>29.</B></div> <div> <B><IMG SRC="23eb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>30.</B></div> <div> <B><IMG SRC="2afb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>31.</B></div> <div> <B><IMG SRC="394b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>32.</B></div> <div> <B><IMG SRC="324b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>33.</B><B> <A NAME="cleft_navicular"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="2d2b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>34.</B></div> <div> <B><IMG SRC="3eeb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>35.</B></div> <div> <B><IMG SRC="36eb40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>36.</B></div> <div> <B><IMG SRC="396b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>37.</B></div> <div> <B><IMG SRC="398b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>38.</B></div> <div> <B><IMG SRC="374b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>39.</B></div> <div> <B><IMG SRC="376b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>40.</B></div> <div> <B><IMG SRC="3bab40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>41.</B><B> <A NAME="tortuous_physis"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="3d4b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>42.</B></div> <div> <B><IMG SRC="3d6b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>43.</B><B> <A NAME="norm_variant_medial_mall"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B></div> <div> <B><IMG SRC="3e8b4b10.jpg" border=0 width="180" height="177" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>44.</B></div> <div> <B><IMG SRC="430b40d0.jpg" border=0 width="180" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>45.</B></div> <div> <B><IMG SRC="486b8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>46.</B></div> <div> <B><IMG SRC="48ab8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>47.</B></div> <div> <B><IMG SRC="48cb8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>48.</B></div> <div> <B><IMG SRC="48eb42c0.jpg" border=0 width="180" height="300" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>49.</B></div> <div> <B><IMG SRC="490b8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>50.</B></div> <div> <B><IMG SRC="492b8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> <B>51.</B></div> <div> <B><IMG SRC="494b8130.jpg" border=0 width="184" height="275" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> </td> <td valign="top" height=380 BGCOLOR="#000000" TEXT="#F7F7FF"> <div> Paediatric leg</div> <div> One of the most important things to look for in the paediatric leg is the <FONT SIZE="4" COLOR="#FFCC66" FACE="Arial" ><B>"occult"</B></FONT> or unseen fracture, sometimes known as the<FONT SIZE="4" COLOR="#FFCC66" FACE="Arial" ><B> "toddlers fracture"</B></FONT>. This is basically a stress fracture often caused by the child starting to walk. It can easily be missed even with perfect radiographs, simply because there is no displacement at all. Think of it like some broken china, often the pieces can be put back together and not see the break at all. </div> <bR> <div> What will often happen here is that the parent will bring the child back after a few days because it is still not using the leg, or the doctor initially told them to come back for further investigation. Either way the child will have further radiographs taken. It is with these follow up radiographs that the reporting radiographer has to pay particular attention. If there is displacement then there should be no trouble seeing it, however, it is possible that there is still no displacement and the fracture itself is still not visible. What the reporting radiographer needs to look for now are the signs of healing. This is usually apparent as periosteal thickening around the fracture. As the fracture is often a spiral along the length of the femur or tibia, this thickening is seen at different parts of the bone on each of the A.P. and lateral views. At this point the diagnosis of a healing undisplaced fracture can be made. Scroll through the first seven images on the left.</div> <bR> <div> Looking at<B> image 1</B> there is no apparent fracture. In <B>image 2</B> the reader should be able to see the fracture but it could be missed by an inexperienced person.</div> <bR> <div> Look at<B> image 3</B>, again the reader could be forgiven for not seeing anything abnormal, although there is a spiral fracture visible. The reader should be able to see a crescent shaped sclerotic (lighter) appearance with a hint of a darker fracture line at the proximal end. This is not a good example of an occult fracture, if it was, the reader  would see nothing abnormal at all.</div> <bR> <div> Again, with<B> image 4</B> it should be possible to see the fracture line across the mid part of the tibia. With this image the fracture should not be missed, again not a good example but the best available at present.</div> <bR> <div> Look now at<B> image 5</B>. This was taken 10 days later. It should be possible to see the periosteal thickening on the medial cortex proximally and distally, and on the lateral cortex at the mid shaft. This is due to the fracture line spiraling around the tibia.</div> <bR> <div> On <B>image 6</B> it should be possible to see the periosteal thickening on the anterior cortex of the tibia.</div> <bR> <div> On <B>image 7</B> taken some weeks later it can be seen that the repair is well under way.</div> <bR> <div> <B>Image 8</B> is a horizontal beam lateral knee showing a <A HREF="id24_lipohaemarthrosis.htm" TARGET="_top" TITLE="Knee"><U>lipohaemarthrosis.</U></A> There is no obvious fracture visible. This patient had a history of recurrent patella dislocations and a skyline view was done, <B>image 9,</B> to check for possible intra articular bony fragments, none were seen but note that the lipohaemarthrosis is also visible in this projection. With careful scrutiny the fracture was seen on the A.P. view, <B>image 10,</B> and was seen to be a subtle, undisplaced <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris</U></A> type 2 fracture of the lateral tibia. If you need help to see it, click on the image.</div> <bR> <div> <B>Image 11</B> shows a possible undisplaced <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris type 2</U></A> fracture of the distal tibia. There seems to be a line of disrupted trabeculae (arrowed). This may be  a projectional anomaly but should be highlighted in the report so that the doctor can assess this area of the patient. As always, the doctor should treat the patient not the radiograph.</div> <bR> <div> <B>Image 12 </B>is an unusual bimalleolar fracture. It is unusual to have fractures of both malleolar epiphyses without affecting the physes. Compare this to the normal variant in <A HREF="id35_l.htm#norm_variant_medial_mall" TARGET="TRLX_Left" TITLE="Paediatric leg"><U><B>image 43.</B></U></A></div> <bR> <div> <B>Image 13</B> is an A.P. view of a hip with a slipped capital epiphysis. It is quite difficult to make the diagnosis from this view alone as it is not entirely dissimilar to the normal side shown in <B>image 14. Image 15</B> is the lateral view and shows the slip quite nicely. <B>Image 16</B> (courtesy of Michael Cotter, Bromley Hospital, Kent) is a more obvious example. These are of course <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris</U></A> type 1 fractures.</div> <bR> <div> <B><U>NORMAL VARIANTS.</U></B></div> <bR> <div> Not so much variants but plain normal, <B>images 17 to 20</B> show the normal epiphyseal / apophyseal lines of the paediatric hip and pelvis. Note in <B>image 17</B>, the separated lesser trochanter, the apophyseal line of the greater trochanter, the epiphyseal line of the head of femur and the unfused acetabulum. <B>Image 18</B>, the apophyseal line of the greater trochanter.<B> Image 19</B>, the apophyseal line of the iliac crest. <B>I</B><B>mage 20</B> shows the suture between the pubic and ischeal ramii. Do not mistake these for fractures!</div> <bR> <div> <B>Image 21 </B>shows the irregular appearance of the developing patella.</div> <bR> <div> <B>Images 22 and 23 </B>show the normal appearance of the paediatric / adolescent tibial tubercle which can often be mistaken for a fracture. The appearance of the developing tibial tubercle varies a lot and can be fragmented. It is important to remember that this is also the site for "Osgood Schlater's" disease. If there is any doubt, pass it on to the radiologist.</div> <bR> <div> <B>Images 24 to 27 </B>show the appearances of the calcaneal apophysis. It can be seen that it can be a single area of ossification as in <B>image 24</B> or multiple as in <B>image 25. Image 26</B> shows a smaller secondary ossification centre high up on the calcaneum, not to be mistaken for an avulsion fracture. <B>Image 27</B> (courtesy of Michael Cotter, Bromley Hospital, Kent) shows the appearance of a very dense apophysis. Note also on <B>image 24</B> that there appears to be an os trigonum developing posterior to the talus. This may fuse to the talus and go unnoticed in the future or it may remain unfused into adulthood and can be mistaken for a fracture of the talus.</div> <bR> <div> <B>Images 28, to 32</B> show the normal appearances of the apophysis of the base of the fifth metatarsal. In the early stages as in <B>image 28</B> it is often mistaken for an avulsion fracture but not so much as growth progresses as in <B>image 29</B>. In <B>image 30</B> it appears to have been avulsed distally but again this is a normal appearance. There is a general rule that says if the separation is longitudinal it is an apophysis and if the separation is transverse it is a fracture. However as with all rules they can be broken, see <B>image 31, </B>here the apophysis is multicentric (more than one ossification centre) and has a  transverse component as well as the usual longitudinal one, and in adulthood some fractures are longitudinal but it is a very good guide. Just remember as always, check for cortication of the fragment. <B>Image 32 </B>is unusual but quite normal, it shows irregular mineralisation of the apophysis.</div> <bR> <div> <B>Image 33</B> appears to be a fracture across the navicular, this is in fact an incomplete fusion of duplicate ossification centres of the navicular, or sometimes referred to as a cleft navicular.</div> <bR> <div> <B>Image 34</B> shows the appearance of irregular ossification of the medial cuneiform.</div> <bR> <div> <B>Image 35 </B>shows a normal appearance of the secondary ossification centre of the head of the first metatarsal. This child attended the fracture clinic because this was initially diagnosed as a fracture by an inexperienced member of staff. Unfortunately they also missed the subtle longitudinal fracture along the shaft.</div> <bR> <div> <B>Images 36 and 37</B> show an unusual appearance of the epiphysis of the head of the second metatarsal. It appears flattened and has two subtle oblique lucencies appearing similar to fractures. It is in fact a multicentric epiphysis.</div> <bR> <div> <B>Images 38 and 39</B> show the appearances of "Harris Lines". These are areas of increased density laid down at the then metaphysis, during periods of growth retardation, which often occur during childhood illness, also known as growth arrest lines. They are quite common and are often multiple, can be seen in any of the long bones but appear more frequently in the distal tibia. They remain in the bone forever and can be seen in radiographs of skeletons from archaeological digs. They should not be confused with impacted fractures which are unlikely to occur perpendicular to the length of the bone and relatively distant from the articulation. Note also the <A HREF="id35_l.htm#tortuous_physis" TARGET="TRLX_Left" TITLE="Paediatric leg"><U>tortuous physis</U></A> and the <A HREF="id25_os_fibulare.htm" TARGET="_top" TITLE="Ankle"><U>os fibulare.</U></A> See also the Harris Line Variant <B>images 45 to 51</B> this page.</div> <bR> <div> <B>Image 40 </B>shows the presence of an exostosis on the second metatarsal. This has probably occurred due to the healing processes involved with the fractures of the second, third and fourth metatarsals. Note also the periosteal thickening around the shafts of  the healing bones. A similar appearance can be seen on the <A HREF="id26_toe_exostosis.htm" TARGET="_top" TITLE="Foot"><U>adult foot page</U></A>.</div> <bR> <div> <B>Images 41 and 42</B> show the appearance of a tortuous physis in the ankle, giving the impression of a <A HREF="id36.htm" TARGET="_top" TITLE="SalterHarris fractures"><U>Salter-Harris fracture</U></A>. This is a quite common appearance, see also <B>image 39,</B> but again the question to be answered is, is there cortication? If the answer is yes then suspect a normal growth variant.</div> <bR> <div> <B>Image 43 </B>shows the medial malleolus with multicentric ossification. This is likely to fuse later in life and go unnoticed, but may remain un-united.</div> <bR> <div> <B>Image 44</B> has quite an array of normal growth variants, all arrowed. It shows "odontoid peg" like epiphyses at the base of the proximal phalanx of the third toe and the base of the terminal phalanx of the second toe, pseudo fractures at the heads of the middle phalanges of the second and third toes, and developmental linear lucencies in the terminal phalanx of the third toe.</div> <bR> <div> <B>Images 45 to 51</B> are a single case study. As previously mentioned in <B>images 38 and 39</B>, Harris lines are growth arrest lines. In this case however this child appears to have multiple lines which are at distinctly regular intervals. You can see in <B>image 45</B> from 1998 that there is indeed a single true Harris Line. Then on <B>images 46 and 47</B> from 2003, the true Harris Line has moved up the shaft (has actually stayed put while the shaft has grown longer) and there are now multiple lines close to the metaphysis. Then in <B>images 48 to 51</B> taken in 2004 there are even more lines at very regular intervals, very striking in appearance in the knee and just visible in the hip. While these are Harris lines, which remember are growth arrest lines, the very regular interval between rules out illness being the cause as a child is extremely unlikely to become ill at such regular intervals. So the probability is that they are drug induced. Regular chemotherapy may produce growth arrest. Looking into this child's history however tells us that they suffer from Osteogenisis Imperfecta and that they underwent drug therapy with Pamidronate, taken at four monthly intervals for two years. Pamidronate is used to slow down osteoclastic activity, this author is still researching the affects and why the growth arrest lines occur. Update later.</div> </td> </tr></table></body>