Question:medium
X-ray of a 5 year old child is shown in the image below. Bone mineral density is normal. Identify the condition.
[X-ray of knee joint showing subperiosteal haemorrhage, scorbutic zone (Trummerfeld zone), dense zone of provisional calcification (White line of Frankel), Ring epiphysis (Wimberger ring), and Pelken's spur]
X-ray of a 5 year old child is shown in the image below. Bone mineral density is normal. Identify the condition.
[X-ray of knee joint showing subperiosteal haemorrhage, scorbutic zone (Trummerfeld zone), dense zone of provisional calcification (White line of Frankel), Ring epiphysis (Wimberger ring), and Pelken's spur]
[X-ray of knee joint showing subperiosteal haemorrhage, scorbutic zone (Trummerfeld zone), dense zone of provisional calcification (White line of Frankel), Ring epiphysis (Wimberger ring), and Pelken's spur]
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Normal bone mineral density with subperiosteal haemorrhages and Frankel's white line on X-ray points to a vitamin deficiency affecting collagen.
Updated On: Jun 23, 2026
- Rickets
- Scurvy
- Metaphyseal dysplasia
- Osteopetrosis
Show Solution
The Correct Option is B
Solution and Explanation
Radiological sign-based approach to identify the condition:
The X-ray shows a 5-year-old child's knee with the following findings:
- Subperiosteal haemorrhage
- Trummerfeld (scorbutic) zone at the metaphysis
- White line of Frankel (dense zone of provisional calcification)
- Wimberger ring epiphysis
- Pelken's spur (lateral metaphyseal spur)
These are pathognomonic signs of scurvy (Vitamin C deficiency).
Why not rickets? Rickets = defective mineralisation $\rightarrow$ reduced bone density, cupping and fraying of metaphysis. The question explicitly states bone mineral density is normal, ruling out rickets.
Why scurvy? Vitamin C is required for collagen hydroxylation. Without it, type I collagen is defective $\rightarrow$ capillary fragility $\rightarrow$ subperiosteal haemorrhages. Bone mineralisation (calcium/phosphate metabolism) remains intact, hence normal BMD.
Osteopetrosis = uniformly dense marble bones. Metaphyseal dysplasia = sclerotic metaphyses, no haemorrhage signs.
\[\boxed{\text{Scurvy (Vitamin C deficiency)}}\]
The X-ray shows a 5-year-old child's knee with the following findings:
- Subperiosteal haemorrhage
- Trummerfeld (scorbutic) zone at the metaphysis
- White line of Frankel (dense zone of provisional calcification)
- Wimberger ring epiphysis
- Pelken's spur (lateral metaphyseal spur)
These are pathognomonic signs of scurvy (Vitamin C deficiency).
Why not rickets? Rickets = defective mineralisation $\rightarrow$ reduced bone density, cupping and fraying of metaphysis. The question explicitly states bone mineral density is normal, ruling out rickets.
Why scurvy? Vitamin C is required for collagen hydroxylation. Without it, type I collagen is defective $\rightarrow$ capillary fragility $\rightarrow$ subperiosteal haemorrhages. Bone mineralisation (calcium/phosphate metabolism) remains intact, hence normal BMD.
Osteopetrosis = uniformly dense marble bones. Metaphyseal dysplasia = sclerotic metaphyses, no haemorrhage signs.
\[\boxed{\text{Scurvy (Vitamin C deficiency)}}\]
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