DOCSLIB.ORG

Stress Fractures: a Diagnostic Problem

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Stress Fractures: a Diagnostic Problem Arch Dis Child: first published as 10.1136/adc.62.8.847 on 1 August 1987. Downloaded from Stress fractures 847 Stress fractures: a diagnostic problem Y WAISMAN, I VARSANO, M GRUNEBAUM, AND M MIMOUNI Departments of Paediatrics B and Paediatric Radiology, Beilinson Medical Center, Petah Tiqva, and the Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel disorder, febrile illness, or weight loss. Physical SUMMARY Three cases of stress fracture, in which examination showed a mild swelling and local diagnosis was aided by sequential radiographs and tenderness in the proximal and medial aspects of the radionuclide scanning are presented; and a pro- right tibia. Blood count, erythrocyte sedimentation cedure for their management, which attempts to rate, and serum calcium and phosphorus concentra- eliminate the need for invasive investigations, is tions and alkaline phosphatase activity were normal. suggested. Radiographs of the right tibia at the time of initial evaluation showed a thick lamellar periosteal reac- tion over the proximal and medial aspect of the Stress fractures in children may present diagnostic tibia; no fracture line was evident, and 99mTc dilemmas, as they may have clinical and pathologi- radionuclide scintigraphy showed increased uptake cal features in common with infectious or malignant across the proximal part of the tibia (Figure 1). conditions. -3 Although stress fractures have been A computed tomography scan showed a non- described previously, the associated problems have specific region of slightly increased medullar den- received scant attention in published reports. sity. A bone biopsy was considered and postponed, and during three weeks observation the symptoms Case reports progressively resolved. Serial radiographs showed thickening of the periosteal reaction and the appear- Case 1. A previously healthy 9 year old girl ance of a horizontal fracture line (Figure 2). A presented at the day care unit with a three week second bone scan, carried out after three weeks history of pain in the right shin and a mild limp. The showed decreased uptake when compared with the pain was constant during the day, but disappeared at previous one and confirmed the diagnosis of stress night. There was no history of trauma nor was there fracture of the right upper tibia. Only then did we any evidence of an learn that the patient underlying bony or metabolic was an amateur ballet dancer. http://adc.bmj.com/ on October 2, 2021 by guest. Protected copyright. 0 I_; Fig. 1 Thick lamellar periosteal reaction over proxrimal Fig. 2 Three weeks later: thickening ofperiosteal reaction posterior and medial aspect ofthe shaft ofright tibia. and appearance ofhorizontalfracture line. Arch Dis Child: first published as 10.1136/adc.62.8.847 on 1 August 1987. Downloaded from 848 Archives of Disease in Childhood, 1987, 62 Case 2. A previously healthy 10 year old boy The differential diagnoses include osteoid osteoma, presented with a two week history of pain in the infection, osteosarcoma, and Ewing's sarcoma.' 3 right tibia and a mild limp. The pain worsened Laboratory estimations-for example, blood count during exercise and lessened at rest. There was no and erythrocyte sedimentation rate may help to history of trauma. Physical examination yielded rule out osteomyelitis. The possibility of a tumour, normal results, except for some swelling and tender- however, is of great concern. In certain cases the ness at the medial aspect of the right tibia. All distinction between these two conditions may be laboratory investigations gave normal results. difficult because the suggestive history of stress Radiographs of the right tibia at the time of initial fracture is often lacking in children and the clinical evaluation showed a thick periosteal reaction over and diagnostic findings are usually not helpful. the medial aspect of the upper shaft of the tibia with Furthermore, even bone biopsies are not always a blurred zone of the compact bone at the medial reliable for definitive diagnosis, because a healing and posterior aspect. Computed tomography did not stress fracture may histologically resemble a bone help, but radionuclide scintigraphy showed in- sarcoma or a Ewing's tumour.' 3 Misdiagnosis has creased activity. Although the clinical and roent- been emphasised by Engh,2 who described nine genographic findings suggested stress fracture with children with stress fractures who had initial diag- subperiosteal haematoma, the possibility of a bone noses of osteoid osteoma, low grade osteitis, and tumour could not be excluded. Complete rest was osteosarcoma. ordered. During the subsequent six weeks of fol- Resolution of symptoms, typical serial x ray low up his symptoms progressively resolved. The changes appearing two to three weeks after the x-ray findings did not change but a second bone scan onset of symptoms,'l 4 and an initial positive clearly showed decreased activity compared with radionuclide bone scan that reverts to normal within that of the first. Subsequent radiographs and bone four to six weeks,5 6 may help to establish the scans performed three and eight months after diagnosis. admission yielded normal results. We therefore agree with Devas' and Engh,2 who maintain that if there is any possibility that a bone Case 3. A 13 year old girl was admitted because of lesion may represent a healing stress fracture biopsy pain just below the left knee, which had lasted for should be avoided unless there is clear evidence that about 10 days. There was no history of trauma. the lesion has not changed radiographically for Physical examination showed slight tenderness and a several weeks. The dilemma of whether to biopsy mild swelling of the proximal medial aspect of her the lesions was raised in all our cases. In cases of left tibia. Laboratory investigations showed no bone lesions with no expansion of the pathological http://adc.bmj.com/ abnormality. Radiographs of the affected tibia process to the soft tissues, where a bone tumour is showed thickening of an area of compact bone over not highly suspected and all laboratory results are the proximal and medial aspect of the metaphysis. A within normal limits, a policy of observation for a radionuclide scan showed increased activity across short period should therefore be adopted. In the the affected area of the tibia, and a stress fracture interim complete rest should be ordered and close was suspected. Her symptoms subsequently re- follow up started. Such management will avoid solved; there was improvement on radiography and unnecessary biopsies. decreased uptake over the affected area on bone on October 2, 2021 by guest. Protected copyright. scan. Stress fracture was confirmed. References Devas MB. Stress fractures in children. J Bone Joint Surg Discussion 1963;45B:528-4 1. 2 Engh CS, Robinson RA, Miegram J. Stress fractures in different children. J Trauma 1970;10:532-40. These three cases represent presentations Special injuries of the musculoskeletal system. Stress fracture. of stress fractures in children. Such injuries are In: Rockwood CA Jr, Wilkins K, King RE, eds. Fractures in uncommon in children, probably because of the children (3). Philadelphia: JB Lippincott, 1984:181-3. increased flexibility of immature bones.3 Devas' has 4 Norfray JF, Schlachter L, Kernahan Jr WT. et al. Early confirmation of stress fractures in joggers. JAMA 198t); shown that the most common site of a stress fracture 243:1647-9. in a child is the upper third of the tibia, and our case 5 Wilcox JR, Monoit AZ, Green JP. Bone scanning in the studies confirmed this. In adults the clinical history evaluation of exercise-related stress injuries. Radiology is the most important feature in diagnosis. The 1977;123:699-703. classic is limb that recurs with a 6 Greaney RB, Gerber FH, Laughlin RL, et al. Distribution and history pain natural history of stress fractures in US marine recruits. particular activity and is relieved by rest.4 In Radiology 1983;146:339-46. children, however, the difficulty in obtaining a Correspondence to Dr Y Waisman. Department of Pacdiatrics A. detailed history greatly limits the physician in this Beilinson Medical Center, Petah Tiqva 49 100, Israel. diagnosis (case 1). Received 8 December 1986.
Load more

Recommended publications
  • Fibular Stress Fractures in Runners
    Fibular Stress Fractures in Runners Robert C. Dugan, MS, and Robert D'Ambrosia, MD New Orleans, Louisiana The incidence of stress fractures of the fibula and tibia is in­ creasing with the growing emphasis on and participation in jog­ ging and aerobic exercise. The diagnosis requires a high level of suspicion on the part of the clinician. A thorough history and physical examination with appropriate x-ray examination and often technetium 99 methylene diphosphonate scan are re­ quired for the diagnosis. With the advent of the scan, earlier diagnosis is possible and earlier return to activity is realized. The treatment is complete rest from the precipitating activity and a gradual return only after there is no longer any pain on deep palpation at the fracture site. X-ray findings may persist 4 to 6 months after the initial injury. A stress fracture is best described as a dynamic tigue fracture, spontaneous fracture, pseudofrac­ clinical syndrome characterized by typical symp­ ture, and march fracture. The condition was first toms, physical signs, and findings on plain x-ray described in the early 1900s, mostly by military film and bone scan.1 It is a partial or incomplete physicians.5 The first report from the private set­ fracture resulting from an inability to withstand ting was in 1940, by Weaver and Francisco,6 who nonviolent stress that is applied in a rhythmic, re­ proposed the term pseudofracture to describe a peated, subthreshold manner.2 The tibiofibular lesion that always occurred in the upper third of joint is the most frequent site.3 Almost invariably one or both tibiae and was characterized on roent­ the fracture is found in the distal third of the fibula, genograms by a localized area of periosteal thick­ although isolated cases of proximal fibular frac­ ening and new bone formation over what appeared tures have also been reported.4 The symptoms are to be an incomplete V-shaped fracture in the cor­ exacerbated by stress and relieved by inactivity.
    [Show full text]
  • Overuse Injuries in Sport: a Comprehensive Overview R
    Aicale et al. Journal of Orthopaedic Surgery and Research (2018) 13:309 https://doi.org/10.1186/s13018-018-1017-5 REVIEW Open Access Overuse injuries in sport: a comprehensive overview R. Aicale1*, D. Tarantino1 and N. Maffulli1,2 Abstract Background: The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments. Methods: We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans. Results: Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management.
    [Show full text]
  • Long Term Treatment of Recurring Pathological Fractures Due to Mccune Albright Syndrome: Case Report and Literature Review
    Vol.2, No.9, 562-567 (2013) Case Reports in Clinical Medicine http://dx.doi.org/10.4236/crcm.2013.29142 Long term treatment of recurring pathological fractures due to Mccune Albright Syndrome: Case report and literature review Yoshvin Sunnassee, Yuhui Shen, Rong Wan, Jianqiang Xu, Weibin Zhang* Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Traumatology and Orthopedics, Shanghai, China; *Corresponding Author: [email protected] Received 17 June 2013; revised 15 July 2013; accepted 10 August 2013 Copyright © 2013 Yoshvin Sunnassee et al. This is an open access article distributed under the Creative Commons Attribution Li- cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In accordance of the Creative Commons Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of the intel- lectual property Yoshvin Sunnassee et al. All Copyright © 2013 are guarded by law and by SCIRP as a guardian. ABSTRACT mentation, precocious puberty and polyostotic fibrous dysplasia (PFD) [1,2]. Patients with PFD have poor bone McCune Albright syndrome is a rare genetic quality and are liable to pathological fractures. We here- disorder which is characterized by café au lait by report the case of a male patient who is treated for 7 skin pigmentation, precocious puberty and poly- years in our center for recurring pathological fractures of ostotic fibrous dysplasia. Treating recurring pa- the femur due to MAS. When the patient was first seen, thological fractures due to Albright syndrome is he presented with a shepherd’s crook deformity of the a very challenging endeavor, and more so when proximal femur.
    [Show full text]
  • Neurofibromatosis with Pancreatic Duct Obstruction and Steatorrhoea
    Postgrad Med J: first published as 10.1136/pgmj.43.500.432 on 1 June 1967. Downloaded from 432 Case reports References KORST, D.R., CLATANOFF, D.V. & SCHILLING, R.F. (1956) APPLEBY, A., BATSON, G.A., LASSMAN, L.P. & SIMPSON, On myelofibrosis. Arch. intern. Med. 97, 169. C.A. (1964) Spinal cord compression by extramedullary LEIBERMAN, P.H., ROSVOLL, R.V. & LEY, A.B. (1965) Extra- haematopoiesis in myelosclerosis. J. Neurol. Neurosurg. medullary myeloid tumors in primary myelofibrosis. Psychiat. 27, 313. Cancer, 18, 727. ASK-UPMARK, E. (1945) Tumour-simulating intra-thoracic LEIGH, T.F., CORLEY, C.C., Jr, HUGULEY, C.M. & ROGERS, heterotopia of bone marrow, Acta radiol. (Stockh.), 26, J.V., Jr (1959) Myelofibrosis. The general and radiologic 425. in 25 cases. Amer. J. 82, 183. BRANNAN, D. (1927) Extramedullary hematopoiesis in findings proved Roentgenol. anaemias. Bull. Johns Hopk. Hosp. 41 104. LOWMAN, R.M., BLOOR, C.M. & NEWCOMB, A.W. (1963) CLOSE, A.S., TAIRA, Y. & CLEVELAND, D.A. (1958) Spinal Thoracic extramedullary hematopoiesis. Dis. Chest. 44, cord compression due to extramedullary hematopoiesis. 154. Ann. intern. Med. 48, 421. MALAMOS, B., PAPAVASILIOU, C. & AVRAMIS, A. (1962) CRAVEN, J.D. (1964) Renal glomerular osteodystrophy. Tumor-simulating intrathoracic extramedullary hemo- Clin. Radiol. 15, 210. poiesis. Report of a case. Acta radiol. (Stockh.), 57, 227. DENT, C.E. (1955) Clinical section. Proc. roy. Soc. Med. 48, 530. PITCOCK, J.A., REINHARD, E.H., JUSTUS, B.W. & MENDEL- DODGE, O.G. & EVANS, D. (1956) Haemopoiesis in a pre- SOHN, R.S. (1962) A clinical and pathological study of 70 sacral tumor (myelolipoma).
    [Show full text]
  • Postpartum Osteoporosis Associated with Proximal Tibial Stress Fracture
    Skeletal Radiol (2004) 33:96–98 DOI 10.1007/s00256-003-0721-2 CASE REPORT I. A. Clemetson Postpartum osteoporosis associated A. Popp K. Lippuner with proximal tibial stress fracture F. Ballmer S. E. Anderson Received: 18 July 2003 Abstract A 33-year-old woman pre- We discuss the presence of a post- Revised: 27 October 2003 sented with acute nonspecific knee partum stress fracture in a hitherto Accepted: 28 October 2003 pain, 6 months postpartum. MR im- undescribed site in a patient who had Published online: 9 January 2004 aging, computed tomography and lactated following an uncomplicated ISS 2004 radiography were performed and a pregnancy and had no other identifi- I. A. Clemetson ()) · S. E. Anderson proximal tibia plateau insufficiency able cause for a stress fracture. Department of Radiology, fracture was detected. Bone densi- University Hospital of Bern, Inselspital, tometry demonstrated mild postpar- Keywords Tibial insufficiency 3010 Bern, Switzerland e-mail: [email protected] tum osteoporosis. To our knowledge fracture · Postpartum osteoporosis · Tel.: +41-31-6322527 these findings have not been de- Dual-energy X-ray absorptiometry · Fax: +41-31-6324874 scribed in this location and in this MR imaging of the knee · clinical setting. The etiology of the Radiography A. Popp · K. Lippuner atraumatic fracture of the tibia is Department of Osteology, University Hospital of Bern, Inselspital, presumed to be due to a low bone 3010 Bern, Switzerland mineral density. The bone loss was probably due to pregnancy, lactation F. Ballmer and postpartum hormonal changes. Knee and Sports Medicine Unit, Lindenhofspital Bern, There were no other inciting causes 3012 Bern, Switzerland and the patient was normocalcemic.
    [Show full text]
  • The Effect of Concentrated Bone Marrow Aspirate in Operative Treatment of Fifth Metatarsal Stress Fractures
    Weel et al. BMC Musculoskeletal Disorders (2015) 16:211 DOI 10.1186/s12891-015-0649-4 STUDY PROTOCOL Open Access The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial Hanneke Weel1*, Wouter H. Mallee1, C. Niek van Dijk1, Leendert Blankevoort1, Simon Goedegebuure3, J. Carel Goslings2, John G. Kennedy4 and Gino M. M. J. Kerkhoffs1* Abstract Background: Fifth metatarsal (MT-V) stress fractures often exhibit delayed union and are high-risk fractures for non- union. Surgical treatment, currently considered as the gold standard, does not give optimal results, with a mean time to fracture union of 12-18 weeks. In recent studies, the use of bone marrow cells has been introduced to accelerate healing of fractures with union problems. The aim of this randomized trial is to determine if operative treatment of MT-V stress fractures with use of concentrated blood and bone marrow aspirate (cB + cBMA) is more effective than surgery alone. We hypothesize that using cB + cBMA in the operative treatment of MT-V stress fractures will lead to an earlier fracture union. Methods/Design: A prospective, double-blind, randomized controlled trial (RCT) will be conducted in an academic medical center in the Netherlands. Ethics approval is received. 50 patients will be randomized to either operative treatment with cB + cBMA, harvested from the iliac crest, or operative treatment without cB + cBMA but with a sham-treatment of the iliac crest. The fracture fixation is the same in both groups, as is the post-operative care.. Follow up will be one year.
    [Show full text]
  • Stress Fracture of the Femoral Neck in a Marathon Runner S
    Br J Sports Med: first published as 10.1136/bjsm.18.1.42 on 1 March 1984. Downloaded from 42 Brit J. Sports Med. - Vol. 18, No. 1, March 1984, pp. 42-43 STRESS FRACTURE OF THE FEMORAL NECK IN A MARATHON RUNNER S. BAER, MB, BSand D. SHAKESPEARE, FRCS Accident Service, John Radcliffe Hospital, Oxford In the wake of recent popular interest in physical fitness Radiographs revealed a complete but undisplaced (Smith, 1983), there has been an increase in exercise- fracture of the femoral neck (Fig. 1). This was treated related injuries. Although the vast majority are minor by internal fixation (a dynamic hip screw). The patient musculo-skeletal problems, care should be taken not to was mobilised partially weight-bearing at 48 hours and miss the more severe injury presenting with non-specific by 12 weeks the fracture had healed. symptoms. The following report describes a stress fracture of the femoral neck occurring in a young COMMENT marathon runner. The majority of reported cases of stress fractures of the femoral neck have been in young military recruits under- CASE REPORT going vigorous training (Kaltas, 1981). A recent report A 36-year-old male University Lecturer presented with has described the injury in young runners (Hajek and severe right thigh pain, present since attempting a mara- Bates Nobel, 1982). thon 5 days previously. The patient began training one year prior to the race and gradually increased his activities to 50 miles per week; mostly on hard road surfaces and wearing purpose built shoes. Two weeks before the race he developed exercise-related pain localised to the medial aspect of the right thigh.
    [Show full text]
  • Pregnancy and Lactation Related Bilateral Stress Fracture of The
    rosis and o P op h e y t s s i c O a f l o A Journal of Osteoporosis & Physical l c Dewilde and Putzeys, J Osteopor Phys Act 2014, 2:2 a t i n v r i u t y o DOI: 10.4172/2329-9509.1000115 J Activity ISSN: 2329-9509 Case Report Open Access Pregnancy and Lactation Related Bilateral Stress Fracture of the Distal Fibula in a Young Woman Dewilde T1* and Putzeys G2 1Department of Orthopaedics and Traumatology, Catholic University Hospitals, Leuven, Belgium 2Department of Orthopaedics, Groeninge Hospital Kortrijk, Belgium *Corresponding author: Dewilde T, Catholic University Hospitals, Leuven, Weligerveld 1, B-3212 Pellenberg, Belgium, Tel: 32 16 33 22 11; E-mail: [email protected] Rec date: Jan 07, 2014; Acc date: April 27, 2014; Pub date: April 30, 2014 Introduction 2). During the revalidation period she used a walker boot for four weeks. Two months postoperatively some mild pain persisted over the We present the case of a 34-year old woman with a bilateral lateral malleolus but the patient could resume her daily activities identical stress fracture of the distal fibula with a two-year interval. including her work as social helper. This pain resolved spontaneously Stress fractures in young patients are most likely fatigue fractures two weeks later. caused by high physical activity, in this report however this was not the case but underlying osteopenia was detected during further exploration. Keywords: Fatigue fracture; Postpartum; Fibula; Osteoporosis Case Report A 34-year-old woman with a clean medical history presented in 2009 with pain in the left lateral malleolus and foot.
    [Show full text]
  • Chondroblastoma: a Rare Cause of Femoral Neck Fracture in a Teenager Michael D
    A Case Report & Literature Review Chondroblastoma: A Rare Cause of Femoral Neck Fracture in a Teenager Michael D. Paloski, DO, Michael J. Griesser, MD, Mark E. Jacobson, MD, and Thomas J. Scharschmidt, MD chanter apophysis, review the literature, and present Abstract learning points for this diagnosis and treatment. Chondroblastomas usually present in the epiphyseal The patient provided written informed consent for region of bones in skeletally immature patients. These print and electronic publication of this case report. uncommon, benign tumors are usually treated with curet- tage and use of a bone-void filler. ASE EPORT Here we report a case of a hip fracture secondary to C R an underlying chondroblastoma in a 19-year-old woman. The patient was an otherwise healthy 19-year-old Open biopsy with intraoperative frozen section pointed white woman who presented to the emergency toward a diagnosis of chondroblastoma. Extended curet- department with the chief report of right hip pain, tage was performed, followed by cryotherapy with a liquid and inability to ambulate after slipping on ice and nitrogen gun and filling of the defect with calcium phos- falling on her left side from standing height. She phate bone substitute. The femoral neck fracture was stated she had a 3-year history of intermittent stabilized with a sliding hip screw construct. The patient right hip pain before this incident. At that time, her progressed well and continued to regain functional sta- primary care physician had worked up her initial tus. A final pathology report confirmed the lesion to be a symptoms with radiographs, which were reported chondroblastoma.
    [Show full text]
  • Osteomalacia in Rheumatoid Arthritis
    Ann Rheum Dis: first published as 10.1136/ard.39.1.1 on 1 February 1980. Downloaded from Annals of the Rheumatic Diseases, 1980, 39, 1-6 Osteomalacia in rheumatoid arthritis SUSAN O'DRISCOLL AND MICHAEL O'DRISCOLL From the Orthopaedic Department, Bristol Royal Infirmary SUMMARY Fifty-four patients with rheumatoid arthritis and severe osteomalacia were found to have considerable bone and general deficiency problems. In 46 of them 14 stress fractures occurred and 32 minimal trauma fractures necessitating admission to hospital. Radiological abnormalities of absorption were found in nearly 25% of the total, implying that dietary factors alone are not always responsible for osteomalacia in patients with rheumatoid arthritis. A high index of suspicion is necessary in the diagnosis of osteomalacia in patients with rheumatoid arthritis, so they may benefit from treatment. Spontaneous and stress fractures have been reported The present study is based on 54 patients with in patients with rheumatoid arthritis (RA), whether RA and osteomalacia leading to pathological or not they were receiving steroids (Haider and fracture or severe bone pain seen in the Orthopaedic et Generalised Department at Bristol Royal Infirmary over a Storey, 1962; Taylor al., 1971). copyright. osteoporosis has been considered important in their period of 2k years. aetiology. Osteomalacia in RA has been reported infrequently, but Maddison and Bacon (1974) Patients and methods reported 5 cases of RA with osteomalacia presenting with spontaneous fractures. They drew attention to Fifty-four patients with RA and severe osteo- its occurrence and how easily it may be overlooked. malacia without any renal or liver disease who In their series dietary deficiency was thought to be presented to the Orthopaedic Department at Bristol the major cause of the osteomalacia.
    [Show full text]
  • Medical Science Pathologic Fractures of Mandible
    Research Paper Volume : 4 | Issue : 9 | Sept 2015 • ISSN No 2277 - 8179 Medical Science KEYWORDS : Pathologic Fractures of Mandible: A Review MDS Oral Medicine and Radiology Lecturer, Department of Oral Medicine and Radiology Dr. Sapna S. Raut Dessai Goa Dental College and Hospital Bambolim - Goa MDS Oral and Maxillofacial surgery Mahatma Gandhi Post-graduate Institute of Dental Dr. Saurabh M. Kamat Sciences Pondicherry MDS Paediatric Dentistry Lecturer in Department of Paediatric Dentistry. Dr. Elaine Barretto Goa Dental College and Hospital Bambolim - Goa MDS Oral Medicine and Radiology Lecturer, Department of Oral Medicine and Radiology Dr. Divya Bhardwaj Goa Dental College and Hospital Bambolim - Goa Dr. Dinesh Francis Senior Lecturer Department of Pedodontics Vydehi Institute of Dental Sciences & Swami Research Centre. Bangalore. ABSTRACT Pathologic fracture is one that occurs in a bone weakened from a preexisting pathological condition. Mandibular pathologic fracture though a rare phenomenon should be suspected when jaw breaks with or without minimal trau- ma. This review discusses various causes of pathologic fracture. It also briefly reviews presentation of pathologic fracture, its diagnosis and management. Dental practitioners examine jaws and advise radiographs very often in their practice therefore, they may be the first to notice such fractures. Dentists should therefore have a thorough knowledge of its etiology, for immediate assessment and management. Introduction: Diagnosing pathologic fractures: A fracture is complete or incomplete discontinuity of bone Investigations need to be first carried out to locate the fracture caused by direct or indirect force. A pathologic fracture is one and its extent. Radiographs like orthopantomogram and poste- that occurs even with a low impact trauma due to weakened ro-anterior view may show destructive radiolucent lesion on the bony architecture from a preexisting pathological lesion [5].
    [Show full text]
  • Stress Fracture and Nonunion of Coronoid Process in a Gymnast
    Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2016, Article ID 9172483, 3 pages http://dx.doi.org/10.1155/2016/9172483 Case Report Stress Fracture and Nonunion of Coronoid Process in a Gymnast T. Hetling,1,2 P. Bourban,1 and B. Gojanovic1,3,4 1 Swiss Federal Institute for Sport (BASPO), Swiss Olympic Medical Center, 2532 Magglingen, Switzerland 2SwissSportclinic,3000Bern,Switzerland 3La Tour Sports Medicine, Swiss Olympic Medical Center, Hopitalˆ de La Tour, Meyrin, 1217 Geneva, Switzerland 4Sports Medicine, Department for Human Locomotion (DAL), Lausanne University and Hospital, 1011 Lausanne, Switzerland Correspondence should be addressed to B. Gojanovic; [email protected] Received 4 March 2016; Accepted 7 June 2016 Academic Editor: Johannes Mayr Copyright © 2016 T. Hetling et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before.
    [Show full text]