Beruflich Dokumente
Kultur Dokumente
injuries
Dr N Muambadzi
Stress fractures (In general) Specific regional injuries
• Epidemiology • Ankle and feet
• Pathophysiology • Leg
• Risk factors • MTSS (Shin splints)
• Presentation • Thigh
• Imaging • Hips and pelvis
• Management • Spondylolysis
• Upper limb
Epidemiology
• Military service -closely linked
• The first report was in 1855
• The Prussian Army Physician Briethaupt described the syndrome of a
painful swollen foot associated with marching hence ‘march fracture’
Pathophysiology
• Bone has a remodelling response to mechanical stress
• Wolff’s Law
• Bone that is subject to a sudden increase in repetitive stress is
vulnerable to stress fracture
• A stress fracture is -type of incomplete fracture in bones
• It is a focal area of increased bone turnover secondary to the
repeated stress
• It could be described as a very small sliver or crack in the bone;
"hairline fracture".
• Osteoblastic response replaces the absorbed bone
• The process of rarefaction is faster than the osteoblastic process and
will progress if the individual continues with stressful activity and
trauma
• Complete fracture through the zone of rarefaction may occur
• Stages in development:
1. Crack initiation
2. Crack propagation
3. Rapid failure of bone
Note: Bone can repair itself quickly if strain removed before 3rd stage
Fatigue fractures
Insufficiency
fractures
Extrinsic
• Training regimen
• Training surface
• Bone anatomy
Intrinsic
• Sex
• Nutrition
• Fitness
• Smoking
• NSAIDS
Clinical features
~ 40% of patients can be asymptomatic
>1 stress fracture can be found in up to 87% of patients
History of unaccustomed & repeated activity
Sequence-pain after exercise, pain during exercise, pain without
exercise
Load related pain-early symptom
Focal bone pain with palpation and stressing- Hallmark
pathophysiology basis of nuclear medicine El Gazaar
Specific regional injuries
• Tendonitis, Strains, Myositis,
Bursitis
• Ankle and foot
• Leg
• Thigh
• Sacral stress fracture
• Upper extremity
• Elbow and forearm
• Wrist and hand
Tendonitis
Strains
Myositis
Bursitis
Ankle and foot
• Femoral neck
High complication rate
Compression type more common- benign
• Pubic Symphysitis
Common among runners
Avulsion of the adductor and rectus abdominis muscles
The symptoms often are vague
Pain referred to the lower abdomen or groin, occasionally with perineal
radiation
• Sacral stress fracture:
In the sacrum, stress fractures are associated with:
• Osteoporosis
• Prior radiation therapy to the pelvis
• The fractures appear as a hot, geographic lesions confined to the sacrum
• Characteristic "butterfly" or "Honda sign" appearance
• High Risk
Predilection for progressing to complete fracture
More aggressive treatment approach
Due to high complication rate treated as acute fracture
Algorith femoral stress gfractures
References
• Journal of orthopaedic trauma, stress fractures Mark R Philipson Paul
J Parker
• Abdelhamid H. Elgazzar (Ed.) The Pathophysiologic Basis of Nuclear
Medicine Second Edition
• Nuclear Medicine in clinical diagnosis and treatment PJ ELL and SS
Gambhir, 3rd edition
• Nuclear medicine the requisites, Harvey Ziessman et al 4th edition
• Atlas of clinical nuclear medicine, Fogelman 3rd edition