1/9. Insufficiency fractures in rheumatic patients: misdiagnosis and underlying characteristics.OBJECTIVE: To report 9 patients with rheumatic diseases referred to our observation due to presumed exacerbation of their rheumatic disease, subsequently diagnosed as stress insufficiency fractures, and to characterize the clinical profile of patients prone to this complication. methods: The medical history of the patients was reviewed with special emphasis on their rheumatic disease, its course, duration and management, their menopausal state, location and characteristics of the fracture, its presentation and the initial presumed diagnosis, the delay in diagnosis, imaging diagnostic tests performed and outcome. Three representative case reports are presented. RESULTS: All 9 patients were women, 8 of them aged 50 years old or more, 8 with rheumatoid arthritis and 1 with polymyalgia rheumatica. They were all treated with corticosteroids and had reduction in their bone mass density when evaluated. Three of the patients presented with subcapital fracture of the femur, 4 had fractures of metatarsal bones and 2 had fractures of the distal tibia. In only one patient was a stress fracture initially suspected. diagnosis was delayed by a mean of 31 days. CONCLUSION: The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed or missed, and thus improperly treated. Increased awareness of this entity is of importance for prompt diagnosis and correct management.- - - - - - - - - - ranking = 1keywords = observation (Clic here for more details about this article) |
2/9. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature.STUDY DESIGN: Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain. OBJECTIVES: To report this unusual case and surgical treatment and to review the relevant literature. SUMMARY OF BACKGROUND DATA: low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature. methods: A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft. RESULTS: The patient achieved complete pain relief, solid fusion, and return to normal function. CONCLUSIONS: In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.- - - - - - - - - - ranking = 9.1421654176243keywords = complaint (Clic here for more details about this article) |
3/9. Identification and management of 2 femoral shaft stress injuries.STUDY DESIGN: Resident's case problem. BACKGROUND: Although femoral shaft stress fractures in the general population are rare, they are more common among endurance athletes and military recruits. Such individuals presenting with a complaint of hip, thigh, or knee pain should raise suspicion for femoral shaft stress injury. A united states Military Academy cadet presented to West Point's Physical Therapy-sports medicine clinic with a complaint of thigh pain related to training with the local marathon team. A second cadet presented to the same clinic during Cadet Basic Training with a complaint of vague but increasing hip, thigh, and knee pain. diagnosis: Both cadets were suspected of having femoral stress injuries, based on clinical exams, and both diagnoses were confirmed with diagnostic imaging. The 2 cadets were both treated conservatively with progressive rehabilitation once healing was confirmed with radiographs. They both responded favorably to conservative management and returned to full athletic activity at approximately 12 weeks. DISCUSSION: Symptoms from a femoral shaft stress fracture can be vague and mimic those of other etiologies. Providers should consider a broad differential diagnosis, to include femoral shaft stress fracture, when treating endurance athletes and military recruits with anterior hip, thigh, or knee pain. Proper imaging confirms the diagnosis and sequential radiographs assist in rehabilitation planning.- - - - - - - - - - ranking = 27.426496252873keywords = complaint (Clic here for more details about this article) |
4/9. Differential diagnosis of a femoral neck/head stress fracture.STUDY DESIGN: Resident's case problem. BACKGROUND: Identifying stress fractures of the hip can be a challenging differential diagnosis. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. DISCUSSION: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity.- - - - - - - - - - ranking = 9.1421654176243keywords = complaint (Clic here for more details about this article) |
5/9. fatigue fracture of the ulna occurring in pitchers of fast-pitch softball.We have reported three cases of fatigue fracture of the ulna in male pitchers of fast-pitch softball. To elucidate the etiology of injury, we first selected three healthy male and three healthy female pitchers from a well-trained college team and analyzed their forearm movement by high-speed cinematography. This showed slight flexion of the elbow joints during wind-up motion, dorsal flexion of the hand joints upon releasing the ball, and extreme pronation of the forearms during the follow-through. We then took 8 mm CT scanning sections of the forearms. Using these images, we investigated shapes and areas of cross-sections of the ulna and its cortical and cancellous bones from the elbow to the hand joints. Our results reveal that the shapes of the sections are significantly different from circles at around the center of the ulna, and the cross-sectional areas are smaller in the middle one-third of the ulna than in other parts. These observations imply that fatigue fractures of the ulna in pitchers of fast-pitch softball must be torsionally induced, tending to occur at the middle one-third of the bone.- - - - - - - - - - ranking = 1keywords = observation (Clic here for more details about this article) |
6/9. Radicular pain after Harrington instrumentation.Three patients developed lumbar radicular pain after Harrington instrumentation and posterior spinal fusion for idiopathic scoliosis. They required a second surgical procedure for nerve root decompression. The presenting complaint after the initial procedure was persistent radicular and buttock pain. Subsequent evaluation revealed direct compression by the inferior hook. At surgery the inferior hook was noted to be encased in bone and had imploded into the canal after a stress fracture of the lamina. Removal of the entire Harrington instrumentation resulted in effective relief of nerve root compression and resolution of radicular pain. To avoid this occurrence the addition of a leg extension to a postoperative brace has been instituted for procedures involving instrumentation to L5 and occasionally to L4.- - - - - - - - - - ranking = 9.1421654176243keywords = complaint (Clic here for more details about this article) |
7/9. Scintigraphic detection of sequential symmetrical metatarsal stress fractures.A patient with complaints of right foot pain and previous normal radiographs had an abnormal three-phase bone scan consistent with a second metatarsal stress fracture. Subsequent radiographs confirmed this diagnosis. Two months later, the patient developed pain in his left foot, and again initial radiographs were noncontributory. A later bone scan revealed a left second metatarsal stress fracture. The results in this case reemphasize the value of bone scintigraphy in patients with foot pain and no bone abnormalities on plain radiographs.- - - - - - - - - - ranking = 9.1421654176243keywords = complaint (Clic here for more details about this article) |
8/9. adolescent stress fractures of the sacrum: two case reports.Two teenage female athletes had low back pain that limited athletic activity. Radiographic examination was negative. A stress fracture of the ala of the sacrum was identified on bone scan and computed tomography (CT) scan. The lesions healed with rest. This unusual lesion has not been reported previously in the pediatric literature, but is probably more common than its lack of documentation suggests. Careful observation and evaluation of athletic individuals will enable identification of this lesion. rest should allow fracture healing, followed by return to sports participation. Stress fractures of the sacrum should be included in the differential diagnosis of adolescent low back pain.- - - - - - - - - - ranking = 1keywords = observation (Clic here for more details about this article) |
9/9. hip pains in a recreational runner.A 29 year old female recreational runner presented with two separate episodes of hip pain. The first, affecting the right hip was an uncommon cause of hip pain--an osteoid osteoma. The second, affecting the left hip was a more predictable cause of hip pain in a runner--a femoral stress fracture. Management of the subsequent stress fracture enabled more detailed and prolonged observation of the natural history and clinical course of the osteoid osteoma. The presentation and management of each of the conditions is discussed.- - - - - - - - - - ranking = 1keywords = observation (Clic here for more details about this article) |