Skip to end of metadata
Go to start of metadata


  • Scurvy is disease that results from vitamin C deficiency
  • Vitamin C (ascorbic acid) deficiency causes failure of collagen synthesis and osteoid formation
  • Results in osteoporosis and possibly spontaneous bleeding


  • Normal collagen synthesis depends upon the hydroxylation of proline and lysine for which vitamin C acts as a cofactor
    • Vitamin C deficiency prevents hydroxyproline and hydroxylysine formation
    • Produced collagen contains only 'non-hydroxylated' proline and lysine
    • The resulting collagen fibrils lack hydrogen bonding and lose mechanical stability
  • Bony pathogenesis consists of two parts
    • Failure to lay down bony matrix
    • Persistence of an unabsorbed calcified cartilage lattice
  • Cartilage cells of the epiphyseal plate multiply and orientate themselves normally 
  • Intervening matrix becomes calcified, but osteoblasts fail to lay down osteoid
  • Calcified cartilaginous matrix is not completely resorbed
  • Epiphyseal plate becomes widened and irregular
  • Spicules of calcified cartilage fracture and a very irregular radiologically dense zone arises at the junction of epiphysis and shaft
  • Failure of resorption of calcified cartilage also makes ring sign

Natural History

  • Onset at 6 months - 2 years
  • Rare in adults

Clinical Presentation

  • Infants are irritable and anaemic
  • Gums may bleed spontaneously
  • Haemorrhage near large joints may cause excruciating pain and tenderness
  • Fractures or epiphyseal separation may occur 

Imaging and Diagnostic Studies

  • Generalised bone rarefaction
  • Most marked in metaphyses of the long bone which may be deformed or fractured
    • Metaphyseal lucency (Trummerfeld Zone)
    • Metaphyseal corner fractures through the weakened lucent parts (Pelkan spurs) results in cupping of the metaphysis
  • Normal calcification in growing cartilage produces dense transverse bands :
    • At juxta-epiphysial zones (Frankel white line) 
    • Around ossific centres of the epiphyses (Wimbergers ring sign)
  • Zones of provisional calcification appear dense
  • Subperiosteal haematomas appear as soft tissue swellings or peri-osseous calcification 


  • Large doses of vitamin C bring prompt relief

Unknown macro: {corr}
Unknown macro: {springerlink}
Unknown macro: {panel}

Internet resources validated by

Unknown macro: {cache}
Unknown macro: {report-on}
Error formatting macro: rss: java.lang.IllegalArgumentException: Invalid uri ' > url encode%&xml_feed=1': Invalid query
Unknown macro: {panel-related}
Unknown macro: {rate}
Cite this page
Unknown macro: {div}

. *

Unknown macro: {page-info}

*. _

Unknown macro: {builder-spacetitle}

. _In: OrthopaedicsOne - The Orthopaedic Knowledge Network. Created

Unknown macro: {page-info}

. Last modified

Unknown macro: {page-info}


Unknown macro: {page-info}

. Retrieved

Unknown macro: {report-info}

, from

Unknown macro: {page-info}


Unknown macro: {builder-hide}
Page contributions
Unknown macro: {div}

The following individuals have contributed to this page:

Unknown macro: {contributors-summary}