DOCSLIB.ORG

Osteochondral Lesion of the Femoral Head in a Fencer: a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Osteochondral Lesion of the Femoral Head in a Fencer: a Case Report (aspects of sports medicine) Osteochondral Lesion of the Femoral Head in a Fencer: A Case Report Yoshihide Nakamura, MD, PhD, Hiromasa Mitsui, MD, PhD, Satoshi Toh, MD, PhD, and Naoki Echigoya, MD, PhD steochondral lesions, condition and to avoid unnecessary months after she first complained of including osteochon- surgical treatment, such as oste- right hip pain (10 months after start- dritis dissecans (OCD) otomy and arthroplasty. The authors ing fencing), she again noticed right in the elbow, knee, and have obtained the patient’s guard- hip pain during fencing, especially Oankle, are very common in athletes.1-3 ian’s written informed consent for when performing lunging or attack- However, there are few reports of print and electronic publication of ing actions. During these actions, osteochondral lesions of the hip.4,5 the case report. the player plants the heel firmly on Weaver and colleagues5 reported 11 cases of femoral head osteochondral lesions in athletes. Other authors have “We emphasize the usefulness of arthroscopy reported subchondral stress fractures to diagnose [osteochondral lesions] and to of the femoral head associated with repeated impaction and axial loads in avoid unnecessary surgical treatment, such young populations.4,6-8 as osteotomy and arthroplasty.” We report a rare case of an osteo- chondral lesion in a young female fencer. Repeated axial impaction CASE REPORT the floor with the right hip in deep force may cause osteochondral A 16-year-old girl had begun fenc- flexion and knee flexed to thrust lesions of the femoral head in addi- ing at age 13. She had suffered from the body forward. The patient pre- tion to stress fractures. This condi- right hip pain 3 months after starting sented to our hospital 10 months tion is easily overlooked because fencing. The symptoms spontane- after the onset of symptoms. She there are less typical clinical find- ously disappeared after a few weeks complained of persisting hip pain and ings. We emphasize the usefulness without any medical treatment. Seven was not able to continue fencing. A of arthroscopy to diagnose this rare A B Dr. Nakamura is Associate Professor, Dr. Mitsui is Research Associate, and Dr. Toh is Professor, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki City, Aomori, Japan. Dr. Echigoya is Chief Orthopedic Surgeon, Department of Orthopaedic Surgery, Kuroishi Hospital, Kuroishi City, Aomori, Japan. C Address correspondence to: Yoshihide Nakamura, MD, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu- cho, Hirosaki City, Aomori, Japan 036- 8562 (tel, 81-172-39-5083; fax, 81-172- 36-3826; e-mail, [email protected] u.ac.jp). Figure 1. (A) Plain radiograph shows very minimal osteosclerotic change of the Am J Orthop. 2009;38(7):356-359. Copyright, Quadrant HealthCom Inc. weight-bearing portion of the femoral head. (B, C) The arthrography showed no 2009. All rights reserved. findings of torn labrum or any free bodies. 356 The American Journal of Orthopedics® Y. Nakamura et al 3A). Mild softening of the articular dition.9-11 Some authors have reported cartilage of the weight-bearing por- OCD following Legg-Calvé-Perthes tion of the femoral head was noted disease, but there are few reports of (Figure 3B). No surgical intervention OCD or osteochondral lesions of the was performed under arthroscopy. femoral head associated with sport After the arthroscopy, the patient activities.12-14 was permitted weight-bearing walking Linden and colleagues15 described as she tolerated the hip pain. She grad- 15 cases of OCD. They reported that A ually returned to fencing 14 months they found no explanation for OCD after the onset of symptoms (2 months other than trauma in 5 patients in after arthroscopy). She fully recov- their series. Weaver and colleagues5 ered and returned to competition-level reported 11 cases of femoral head fencing 15 months after the onset of osteochondral lesions in athletes. In symptoms. Therefore, 5 months of only 4 of these 11 cases did the repose were needed for full recovery patients recall a discrete traumatic until she returned to the sport. She event preceding the onset of the hip B C continued fencing for 19 months until pain. The authors postulated that she graduated from high school. transient subluxation with resultant When the patient visited our shearing force or impaction force, hospital 4 years after the onset of such as the force in sudden stops symptoms, she did not complain of or landing from jumps, is a mecha- any symptoms around the hip. The nism for occurrence of osteochondral D E mobility of the affected hip was nor- lesion of the hip. They claimed that mal without pain during motion. The MRI evidence of damage to the joint Figure 2. (A) High-uptake lesion was radiographs at the latest follow-up capsule and associated soft-tissue seen in bone scintigram at the femoral showed no abnormal findings except injuries, such as hematoma or edema head. There was a low-signal area in mild residual sclerotic lesion of the in muscles or fat, would not neces- the upper part of the femoral head both femoral head (Figure 4A). A remark- sarily be expected from impaction in T1-weighted (B, C) and T2-weighted ably diminished, small, low-signal force because all the abnormal forces (D, E) magnetic resonance images. lesion of the upper part of the femoral would be transmitted directly to the There were no findings of bone mar- head was confirmed on MRIs at the joint itself. Our case also had no defi- row edema in the acetabulum. latest follow-up (Figures 4B-4E). nite injury or trauma and also showed no evidence of soft-tissue changes at plain radiograph showed very mini- initial examination. mal change of osteosclerosis of the DISCUSSION Etiology of osteochondral lesion weight-bearing portion of the femoral Previous epidemiologic studies have or OCD is still unclear and multi- head (Figure 1A). The arthrography shown that hip injuries constitute 5% factorial.8 Several causes have been showed no findings of torn labrum to 9% of injuries sustained by high postulated, including inflammation, or any free bodies (Figures 1B, 1C). school athletes. Osteochondral lesion genetics, ischemia, ossification, and A high-uptake lesion was seen in of the femoral head is a very rare con- repetitive trauma. Kusumi and col- bone scintigram at the femoral head (Figure 2A). There was a low-signal area in the upper part of the femoral head in both T1-weighted (Figures 2B, 2C) and T2-weighted magnetic resonance images (MRI) (Figures 2D, 2E). There were no findings of bone marrow edema in the acetabulum. Although the patient was restricted from fencing, avoided partial weight- bearing, and used double crutches for 2 months, her hip pain remained. For further investigation, we performed an arthroscopy of the right hip. There were no abnormal findings at the ace- A B tabular cartilage. The labrum did not Figure 3. (A) The labrum shows no injury. (B) Softening of the articular cartilage show a tear or detachment (Figure of the weight-bearing portion of the femoral head was confirmed. July 2009 357 Osteochondral Lesion of the Femoral Head in a Fencer There were no findings of obvi- ous cartilage changes in MRIs. In our case, arthroscopy revealed mild softening of the joint cartilage of the femoral head without soft-tissue injuries. Arthroscopy was useful for B C denying detachment of the labrum, for which the MRI did not provide any findings.19,20 Conservative treatments successfully relieved the symptoms in the present case, although a small, abnormal-signal lesion remained only in the MRI. A D E When a young athlete complains of Figure 4. (A) Radiograph at the latest follow-up shows no abnormal findings hip pain, the surgeon should consider except mild residual sclerotic lesion of the femoral head. An extremely small osteochondral lesion of the femoral low-signal lesion of the upper part of the femoral head was still seen both in head. It is essential to perform a dif- T1-weighted (B, C) and T2-weighted (D, E) magnetic resonance images. ferential diagnosis from necrosis of the femoral head through careful esti- 16 leagues studied the mechanism of T1-weighted and T2-weighted MRIs mation of the radiographs, MRIs, and progression of osteochondral lesions reflected the healing process of the bone scintigram. Arthroscopy may in the elbow histopathologically. lesion. The absence of low–signal be useful in confirming the absence They revealed that the primary patho- intensity lesions on T1-weighted of osteochondral loose bodies or logical changes of the condition were MRIs and high–signal intensity torn labrum, as reported by Edwards 19 due to damage of articular cartilage lesions on T2-weighted MRIs was and colleagues and Kelly and col- induced by repeated stress. In our due to an adequate period passing leagues.20 To treat osteochondral case, we believe repeated impaction to allow for healing of bone marrow lesions, one needs to rest the joint and and axial loads to the femoral head in edema. Osteochondral lesions should carefully observe the symptoms. The the lunge action of fencing were the be differentiated from osteonecrosis symptoms should disappear in 4 to 6 primary cause of this condition. of the femoral head in order to pro- months by restricting sports activity, “Because repeated impaction force to the hip joint may be a cause of osteochondral lesions of the femoral head, the surgeon should consider this condition when a young athlete exposed to such impaction force presents with hip pain.” In recent years, some authors have vide appropriate treatment. The typi- including limitation of weight-bear- reported stress fractures of the femoral cal finding of osteonecrosis of the ing.
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]