scholarly journals Injuries of Children and Young People in Sports: Stress Fractures and Fracture of the Sleeve Sleeve

2018 ◽  
Vol 6 (6_suppl3) ◽  
pp. 2325967118S0005
Author(s):  
Ana Costa Pinheiro ◽  
Filomena Ferreira ◽  
Margarida Areias ◽  
Carolina Oliveira ◽  
Cristina Sousa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Young People ◽  
Avulsion Fracture ◽  
Stress Fractures ◽  
Overuse Injuries ◽  
Resonance Imaging ◽  
Children And Young People ◽  
Sleeve Fracture ◽  
Clinical Cases

Introduction: With the dramatic increase in the competitive sports of children and young people, overuse injuries have become more important in the pediatric population. Among these, the most frequent injuries in young athletes are stress fractures. The absence of evident traumatic history and the subtle radiographic changes can cause a diagnostic difficulty and delay the treatment. Fracture of the patella sleeve is a rare fracture only occurs in children. The diagnosis is difficult, both clinically and radiologically. High patella and hemarthrosis are important signs to diagnose this fracture. Presentation of 2 clinical cases of injuries in children and young people in sports: stress fractures and fracture of the patella sleeve. Methods: Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: We present a case of a child, a 13-year-old soccer practitioner who had mentioned well localized pain in the anterior aspect of the right leg with 5 days of evolution and analgesic gait and no history of trauma. The radiographs and CT showed a juxtaposed cortical lesion with apparent contact with the cortical bone without associated periosteal reaction. NMR confirmed stress fracture of the proximal tibial shaft. It was treated conservatively with immobilization with plaster and discharge. We present the case of an 11-year-old boy who suffered a fracture of the patella sleeve. In the imaging study, a fragment of bone with a displacement from the lower pole of the patella was visible. An open fracture reduction was performed. During the surgery confirmed avulsion fracture of a small osteochondral fragment, configuration of a sleeve-like fracture. The amount of cartilage was small, so it was decided to reinsert the 2 anchorages for patellar tendon. After fracture healing and rehabilitation, both returned to sports activity without sequelae or functional limitations. Discussion/Conclusion: A knowledge of the fracture of the patella sleeve, together with its clinical and radiological features, is important to avoid misdiagnosis and treatment delay. Care should be taken not to disturb the proximal tibial process. Although relatively uncommon in the pediatric age, the incidence of fractures described stress have been increasing in this age group. A high degree of suspicion is required to make the diagnosis and avoid too invasive treatment. REFERENCES Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992;32:464–7. Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193:825–7. Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991;19:525– 8. Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979;61:165–8. Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995;77:1721–3. Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999;7:243–5. Fredericson M, Bergman G, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-81. Hunter-Griffin LY. Clinics in sports medicine: overuse injuries. Philadelphia (PA): W.B. Saunders, 1987. Jackson DW, Bailey D. Shin splints in the young athlete: a non-specific diagnosis. Phys Sports Med 1975; 3: 45-51.   

scholarly journals Bilateral stress fracture of the femoral neck in association with simultaneously developing osteonecrosis of the femoral head: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tomofumi Nishino ◽  
Hisashi Sugaya ◽  
Naoya Kikuchi ◽  
Yu Watanabe ◽  
Hajime Mishima ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Femoral Head ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Overuse Injury ◽  
Early Stage ◽  
Stress Fractures ◽  
Resonance Imaging ◽  
Femoral Neck Stress Fracture

Abstract Background Femoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture. Case presentation A 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery. Conclusions Bilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient’s complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.

scholarly journals Magnetic resonance imaging can diagnostic early morphofunctional changes in the myocardium in young people with type 1 diabetes

2019 ◽  
Vol 10 (1) ◽  
pp. 29-35
Author(s):  
Kirill A. Popov ◽  
Irina Z. Bondarenko ◽  
Elena V. Biryukova ◽  
Elena V. Averkieva ◽  
Alexander V. Vorontsov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Type 1 Diabetes ◽  
Magnetic Resonance ◽  
Young People ◽  
Left Ventricle ◽  
Contrast Agent ◽  
Young Patients ◽  
Resonance Imaging ◽  
Functional Changes

Aim. To study the morphofunctional state of the myocardium in young people with diabetes mellitus 1 using magnetic resonance imaging (MRI) technology. Materials and methods. 38 patients (14 men, 24 women), aged 18 to 36 years old, with an experience of type 1 diabetes from 5 to 16 years old were underwent contrastive MRI of the heart. The exclusion criteria were: pronounced electrolyte disorders in the blood, dysproteinemia, chronic liver and kidney failure - glomerular filtration rate (EPI)≤60 ml/min/1.73 m2, thyroid dysfunction, obesity (body mass index ≥30 kg/m2), diagnosed cardiovascular diseases, contraindications for MRI. The indicators of functional changes in the left ventricle (circular strain, strain relaxation index - SRI), peak early diastolic strain (PSRDS) were obtained and the accumulation of the contrast agent in the delayed period were assessed. Results. The obtained results of strain, SRI, PSRDS do not allow to exclude the presence of functional changes in the myocardium of the left ventricle. In 42.11%, zones of accumulation of the contrast agent were visualized in the delayed period (insignificant - 28.95% and moderate accumulation - 13.16%), mainly by the endocardium of the cardiac apparatus (mitral and tricuspid), and in one observation (2.9%) - in combination with unexpressed diffuse heterogeneity of the myocardium of the left ventricle. Conclusion. MRI of the heart is a promising direction in the assessment of early morphofunctional changes in the structure of the myocardium, which will probably make it possible to predict life-threatening changes in the heart muscle in young patients with type 1 diabetes.

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