Rickets secondary to hepatobiliary disease is a rare condition; however, the skeletal manifestations are similar to simple nutritional rickets. These skeletal changes include epiphyseal plate abnormalities, pseudofractures, bowing of long bones, scoliosis, and fractures. One-hundred and twelve charts and radiographs of patients with chronic hepatobiliary disease admitted to Children's Hospital of Michigan from 1968 to 1978 were reviewed. Nineteen, or 17%, of these patients showed roentgenographic evidence of rickets. Orthopedic management is primarily concerned with the treatment of fractures and prevention or correction of deformities in those children whose longevity justifies treatment.