scholarly journals Pes Planus and Distal FIbular Stress Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Jet Liu ◽  
William Granberry
Keyword(s):  
Stress Fracture ◽  
Inclination Angle ◽  
Case Series ◽  
Stress Fractures ◽  
Lateral Malleolus ◽  
Foot Deformities ◽  
Distal Fibula ◽  
Pes Planus ◽  
Independent Observer ◽  
Radiographic Measurements

Category: Ankle, Hindfoot Introduction/Purpose: Fibular stress fractures accounts for 4.6% to 21% of all stress fractures. There have been isolated reports of distal third fibular stress fractures within 4-7 cm of the tip of the lateral malleolus in young and athletic patients related to overuse injuries. We examine a case series of middle aged female patients with planovalgus foot deformities and associated hindfoot valgus who presented with distal third fibular stress fractures. We propose that this type of distal fibular stress fracture is a result of increased stress loading of the distal fibula at the superior margin of tibio-fibular interosseous ligaments. Methods: From October 2015 through September 2016, we evaluated six patients (six cases) who presented to Baylor College of Medicine foot and ankle specialty clinic. These patients were found to have distal fibular stress fractures. Detailed initial history was documented. The diagnosis of distal fibular stress fracture was confirmed with both clinical examination and radiographic evidence among all patients. Additionally, all patients were found to have planovalgus deformity with associated hindfoot valgus. Radiographic measurements were taken in all patients, including lateral talo-calcaneal angle, Meary’s angle, calcaneal inclination angle, and AP tibio-talar angle. Distance of distal fibular stress fracture location to tip of lateral malleolus, as well as the distance between medial cuneiform and 5th metatarsal were measured. Single independent observer performed all measurements. Results: Among the six patients in the study, all were female, with average age of 58 years (45-64). Four patients carried the diagnosis of osteopenia and/or osteoporosis from DEXA scan. There is no evidence of association with tobacco use or alcohol use. The mean radiographic distance between location of stress fracture to tip of lateral malleolus is 5.8 cm (4.2cm-7 cm). There was evidence of pes planus from Meary’s angle, which averaged 6.7° (3°-11°) convex downward, and measurement of calcaneal inclination angle averaged 19° (13°-30°). Furthermore, measurement of tibio-talar angle averaged 1.7° valgus alignment consistent with chronic hindfoot valgus deformity. While all patients were treated successfully with immobilization, one patient underwent medial calcaneal osteotomy to correct the hindfoot valgus after recurrent fracture. Conclusion: It is hypothesized that increased stress loading of the fibula due to lateralization of the load axis contributes to this condition. The apex of this stress culminates in the lateral aspect of the fibula above the distal tibio-fibular ligament complex and results in a characteristic valgus fracture of the fibula. The increased stress from deformity results in the fracture rather than increased load from exercise or other repetitive stress. The significance of this proposition is that recognition of this type of fracture should lead the clinician to address the underlying planovalgus deformity in the treatment of this fracture type.

scholarly journals Isolated Fibular Stress Fractures: Demographic and Radiographic Factors

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Nana O. Sarpong ◽  
Matthew Levitsky ◽  
Michael Held ◽  
Justin K. Greisberg ◽  
J. Turner Vosseller
Keyword(s):  
Risk Factors ◽  
Stress Fracture ◽  
Demographic Data ◽  
Case Series ◽  
Stress Fractures ◽  
Prior History ◽  
Retrospective Case ◽  
Distal Fibula ◽  
Retrospective Case Series ◽  
Short Period

Category: Ankle, Trauma Introduction/Purpose: Fibular stress fractures are rare injuries that are incompletely understood in terms of pathogenesis and predisposing factors. While stress fractures all involve relative stress concentration in a finite area leading to local mechanical failure, the risk factors for this injury have not been assessed. Their relative rarity has made understanding of these risk factors difficult. In a retrospective case series, we sought to define demographic and radiographic risk factors for isolated fibular stress fractures. Methods: We retrospectively reviewed the records of 13 patients with isolated fibular stress fractures at our institution between January 2010 and November 2018. We collected and analyzed baseline demographic data and radiographic parameters including prior history of fracture, location of stress fracture, bone quality, and heel alignment. Results: The cohort consisted of 6 men and 7 women with a mean age of 41.8 years at the time of diagnosis of the fibular stress fracture. The average BMI in the cohort was 28.5 kg/m2. The location of the stress fracture was in the distal third of the fibula in 69.2% (9/13), proximal third in 23.1% (3/13), and middle third in 7.7% (1/13). There was no evidence of osteopenia on radiographic analysis in any patients, by assessment of the senior author and attending radiologist at our institution. Isolated stress fractures in the distal third of the fibula were observed more commonly in women. Distal fibula stress fractures were associated with physiologic hindfoot valgus, while proximal fractures were seen with a varus hindfoot. Conclusion: In this retrospective case series of a rare injury, isolated stress fractures in the distal third of the fibula were the most common fibular stress fracture. Proximal fibular stress fractures were associated with a varus hindfoot. All fractures in this case series healed with immobilization in a walking boot with or without a short period of nonweightbearing.

Surgical management of chronic pelvic instability following periacetabular osteotomy nonunion

2020 ◽  
Vol 30 (6) ◽  
pp. 787-792
Author(s):  
Alexander D Shearman ◽  
Aresh Hashemi-Nejad ◽  
Marcus JK Bankes ◽  
Angus D Lewis
Keyword(s):  
Stress Fracture ◽  
Soft Tissues ◽  
Periacetabular Osteotomy ◽  
Case Series ◽  
Stress Fractures ◽  
Pubic Ramus ◽  
Ilioinguinal Approach ◽  
Superior Pubic Ramus ◽  
Stoppa Approach ◽  
Pelvic Instability

Introduction: Periacetabular osteotomy (PAO) is an established treatment for symptomatic acetabular dysplasia in skeletally mature individuals without arthritis. Pelvic nonunion and associated stress fractures are under-reported. Nonunited stress fractures can cause continued buttock pain and pelvic instability. The aim of this study is to report on our experience managing patients with ongoing pain following nonunion of PAO. Patients and methods: 8 patients presented to a tertiary referral pelvic service with symptomatic PAO nonunion between 2015-2018. All patients underwent open reduction internal fixation of the superior pubic ramus nonunion, with ipsilateral iliac autograft, at an average of 48.1 (15–82) months following initial osteotomy. Demographic and perioperative data were recorded. Follow-up was on average to 9.9 months, once union was confirmed radiographically. Results: All patients were female and average age was 31.8 (18–41) years. In 7/8 (87.5%) patients a modified Stoppa approach was successfully utilised. 1 patient required an ilioinguinal approach due to the amount of rotational correction. All patients went on to union at the superior pubic ramus and reported improvement in mechanical symptoms. 5/8 (62.5%) patients were noted to develop union of the posterior column or inferior pubic ramus stress fracture indirectly. 2/8 (25%) patients developed progression of intra-articular pain, despite restoration of pelvic stability. 1 patient required intraoperative transfusion due to femoral vein injury. There were no other complications seen in this series. Conclusions: To our knowledge, this is the largest case series of surgically managed PAO nonunion. Pelvic instability resulting from nonunion and stress fracture can be satisfactorily addressed by mobilising, grafting and plating the nonunion at the superior pubic ramus. The modified Stoppa approach is suitable in most cases, allowing excellent exposure whilst minimising the insult to soft tissues. The altered anatomy of the pelvis following PAO should be anticipated to reduce the risk to nearby neurovascular structures.

scholarly journals A Computer Model Assessment of the Effect of Hindfoot Alignment on Mechanical Axis Deviation and Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Naven Duggal ◽  
Patrick Williamson ◽  
Ara Nazarian
Keyword(s):  
Compressive Stress ◽  
Lower Limb ◽  
Muscle Force ◽  
Mechanical Axis ◽  
Stress Fractures ◽  
Biomechanical Study ◽  
Lateral Malleolus ◽  
Axis Deviation ◽  
Pes Planus ◽  
Mechanical Axis Deviation

Category: Basic Sciences/Biologics Introduction/Purpose: Conventional mechanical axis is calculated from the center of the femoral head to the center of the ankle. Mechanical axis deviation of the lower limb can be associated with a pes planus hindfoot. Malalignment of the lower limb has been shown to increase progression of osteoarthritis of the knee and ankle and decrease joint arthroplasty longevity. Clinically, a pes planus hindfoot has also been seen with patients who present with a stress fracture of the lateral malleolus. This biomechanical study aims to utilize computer modeling to evaluate the hypothesis that altered force transmission on the lateral malleolus with resultant stress fractures in a pes planus model is attributable to mechanical axis deviation. Methods: A free-body diagram of the fibula in single leg stance was generated by modeling the fibula as a uniform cylinder. It includes the axially applied load and a single evertor muscle force as an eccentric load applied to the mid-diaphysis . Previously derived relationships between body weight (BW = 667 N, 150lbs) and a) normal axial fibula load (BW*0.17) and b) muscle force (BW*0.25) were used. Fibula length (286.5 mm) and diameter (8 mm) were derived from anthropological data. Mechanical axis deviation in pes planus was simulated in two manners: 1) increased (2 and 3 times normal) axial fibula load and 2) increased evertor muscle force. The compressive stress along the length of the bone was determined through static analysis and the total applied load was compared to theoretical Euler buckling load. Results: Increasing the load on the fibula, either by increasing the axial load (Figure 1A) or the muscle load (Figure 1B), increases the maximum compressive stress below the lateral muscle origins, namely the section between the distal tibiofibular ligaments and the evertor muscles. The compressive stress for both cases was less than the compressive yield stress of cortical bone (200 MPa) and cancellous bone (100 MPa) even as the force was increased to the critical buckling value. This model serves as a first attempt to relate the spatial distribution of stress in the fibula with muscle force, axial load, and compressive stress in light of distal fibular fractures associated with pes planus. Conclusion: The importance of lower extremity mechanical axis deviation is well established in the progression of arthritis in the knee and ankle. The role of the mechanical axis in the predisposition of stress fractures around the ankle has not been evaluated in the literature. This biomechanical study represents the first attempt to understand how deviation of the mechanical axis can result in stress fractures of the lateral malleolus. Future studies including a finite element analysis will provide further information and the results of these studies may alter how clinicians treat patients with stress fractures of the fibula.

Tarsal Navicular Stress Injury

2005 ◽  
Vol 33 (12) ◽  
pp. 1875-1881 ◽  
Author(s):  
Scott G. Burne ◽  
Chris M. Mahoney ◽  
Bruce B. Forster ◽  
Michael S. Koehle ◽  
Jack E. Taunton ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Stress Fracture ◽  
Case Series ◽  
Stress Fractures ◽  
Computed Tomographic ◽  
Imaging Parameters ◽  
Previous Level ◽  
Long Term Follow Up

Background Tarsal navicular stress fracture is a condition that has curtailed many athletic careers. Management protocols remain varied and somewhat controversial. Hypotheses (1) Clinical practice does not mirror the recommendations reported from previous case series. (2) Clinical outcome is poor when navicular stress fracture is managed in a variety of ways. (3) Imaging does not correlate strongly with clinical status at long-term follow-up after navicular stress fracture. Study Design Case series (prognosis); Level of evidence, 4. Methods From a computer registry, we identified patients who had attended a university sports medicine center between 1996 and 2002 and whose final diagnosis was navicular stress fracture (n = 11) or navicular stress reaction (n = 9). All patients had provided demographic and clinical data at their original evaluation, and all had undergone bone scans and computed tomographic imaging. These data were extracted by chart review. Follow-up clinical and imaging assessments took place a median of 3.7 years later (range, 1-15.7 years). At these assessments, we administered a questionnaire, performed a structured physician examination (blinded to other data), scanned both feet with computed tomography, and obtained magnetic resonance images of the affected foot. Results Only 2 of 11 patients (18%) with navicular stress fractures received the literature-recommended treatment of at least 6 weeks’ nonweightbearing cast immobilization. Of these 11 patients, only 6 (55%) returned to sports at their previous level. Only 3 patients with navicular stress fractures regained normal imaging appearance at follow-up. Pain score, stiffness, sporting success, current sporting involvement, and recurrence/time to recurrence were not statistically associated with computed tomographic or magnetic resonance imaging parameters. Of 9 patients with navicular stress reactions, 7 developed clinical and radiological features of navicular stress fracture, but 6 of 9 patients (67%) returned successfully to sports. Conclusions Contemporary management of navicular stress fracture differs from that recommended in the literature. This stress fracture prevented almost half of the participants in this study from returning to sports at their previous level. Imaging parameters do not correlate with the clinical assessment of a patient at long-term follow-up of navicular stress fracture.

Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture

2020 ◽  
Vol 41 (4) ◽  
pp. 419-427 ◽  
Author(s):  
Ki Won Young ◽  
Jin Su Kim ◽  
Hong Sup Lee ◽  
Hyuk Jegal ◽  
Young Uk Park ◽  
...  
Keyword(s):  
Stress Fracture ◽  
Screw Fixation ◽  
Demographic Data ◽  
Case Series ◽  
Stress Fractures ◽  
Radiographic Evaluation ◽  
Return To Sports ◽  
Plating Technique ◽  
Fracture Management

Background: The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. Methods: Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. Results: The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. Conclusion: With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. Level of Evidence: Level IV, case series.

The Use of Modern Intramedullary Nailing in Distal Fibula Fracture Fixation

2018 ◽  
Vol 12 (4) ◽  
pp. 322-329 ◽  
Author(s):  
Joseph Tracey ◽  
Tyler J. Vovos ◽  
Danny Arora ◽  
Samuel Adams ◽  
Selene G. Parekh
Keyword(s):  
Case Series ◽  
Lateral Malleolus ◽  
Wound Complications ◽  
Peroneal Tendon ◽  
Syndesmotic Injury ◽  
Fixation Device ◽  
Distal Fibula ◽  
Minimal Incision ◽  
Lateral Incision ◽  
Incision Wound

Background. Lateral malleolus (LM) fixation is necessary for unstable ankle fractures. Traditional fixation relies on the use of plates through a lateral incision, wound healing can be an issue for such incisions. A novel intramedullary (IM) fixation device has been developed that can be placed through a minimal incision. The purpose of this study was to demonstrate the clinical efficacy of this device. Methods. A retrospective analysis was performed on patients who received IM fixation for isolated fibula, bimalleolar (BM), and trimalleolar (TM) fractures. Pertinent demographic information, operative factors, complications, and clinical outcomes were recorded. Results. Sixteen patients were included in the study with an average age of 59 years (range 35-86 years). Six patients presented with isolated LM fractures, four patients had a BM fracture with a syndesmotic injury, 2 patients sustained a LM fracture with an associated syndesmotic injury, 2 patients had a BM fracture, and 2 patients had a TM fracture with a syndesmotic injury. There was a 100% healing rate of the lateral malleolus without any cases of malunion or shortening. There were no cases of sural nerve or peroneal tendon injuries, nor any wound complications found. Conclusion. These findings demonstrate the safe and efficacious use of a novel intramedullary fixation device for fibula fractures with lower wound complications compared with published outcomes found with lateral fibular plating. The features of this device allow for reliable fixation of the fibula, maintaining length and minimizing wound issues. Levels of Evidence: Level IV: Case series

Tibial Stress Fracture Following Ankle Arthrodesis

2020 ◽  
Vol 41 (5) ◽  
pp. 556-561
Author(s):  
Mohamed Abdelaziz Elghazy ◽  
Noortje C. Hagemeijer ◽  
Gregory R. Waryasz ◽  
Daniel Guss ◽  
Seth O’Donnell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stress Fracture ◽  
Plate Fixation ◽  
Distal Tibia ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Stress Fractures ◽  
Index Procedure ◽  
Fibular Osteotomy ◽  
Tibial Stress Fracture

Background: End-stage ankle arthritis is frequently treated with either tibiotalar or tibiotalocalcaneal (TTC) arthrodesis, but the inherent loss of accommodative motion increases mechanical load across the distal tibia. Rarely, patients can go on to develop a stress fracture of the distal tibia without any antecedent traumatic event. The purpose of this study was to determine the incidence of tibial stress fracture after ankle arthrodesis, highlight any related risk factors, and identify the effectiveness of treatment strategies and their healing potential. Methods: A retrospective chart review was performed at 2 large academic medical centers to identify patients who had undergone ankle arthrodesis and subsequently developed a stress fracture of the tibia. Any patient with a tibial stress fracture before ankle arthrodesis, or with a nontibial stress fracture, was excluded from the study. Results: A total of 15 out of 1046 ankle fusion patients (1.4%) developed a tibial stress fracture at a mean time of 42 ± 82 months (range, 3-300 months) following the index procedure. The index procedure for these 15 patients who went on to subsequently develop stress fractures included isolated ankle arthrodesis (n = 8), ankle arthrodesis after successful subtalar fusion (n = 2), primary TTC arthrodesis (n = 2), and ankle arthrodesis subsequent to successful subtalar fusion with resultant ankle nonunion requiring revision TTC nailing (n = 3). Four patients had undergone fibular osteotomy with subsequent onlay strut fusion, and 5 had undergone complete resection of the lateral malleolus. Stress fracture location was found to be at the level of the fibular osteotomy in 2 patients and at the proximal end of an existing or removed implant in 9. Fourteen of the 15 patients had a nondisplaced stress fracture and were initially treated with immobilization and activity modification. Of these, 3 failed to improve with nonoperative treatment and subsequently underwent operative fixation (intramedullary nail in 2; plate fixation in 1). Only 1 of the 15 patients presented with a displaced fracture and underwent immediate plate fixation. All patients reported pain improvement and were ultimately healed at final follow-up. Conclusion: In this case series review, we found a 1.4% incidence of tibial stress fracture after ankle arthrodesis, and both hardware transition points and a fibular resection or osteotomy appear to be risk factors. Operative intervention was required in approximately 25% of this population, but the majority of tibial stress fractures following ankle fusion were successfully treated nonoperatively, and ultimately all healed. Level of Evidence: Level IV, retrospective case series.

scholarly journals The Treatment and Outcomes of Medial Malleolar Stress Fractures

2014 ◽  
Vol 6 (6) ◽  
pp. 527-530 ◽  
Author(s):  
Val Irion ◽  
Timothy L. Miller ◽  
Christopher C. Kaeding
Keyword(s):  
Stress Fracture ◽  
Treatment Options ◽  
Case Series ◽  
Return To Sport ◽  
Stress Fractures ◽  
Return To Play ◽  
Cochrane Library ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence

Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.

scholarly journals Tibial Stress Fracture After Ankle Arthrodesis: Case Series with Different Treatment Modalities

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0008
Author(s):  
Mohamed E. Abdelaziz ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Seth O’Donnell ◽  
Brad Blankenhorn ◽  
...  
Keyword(s):  
Stress Fracture ◽  
Case Reports ◽  
Case Series ◽  
Ankle Arthrodesis ◽  
Nonoperative Treatment ◽  
Stress Fractures ◽  
Treatment Modalities ◽  
Ankle Arthritis ◽  
Fibular Osteotomy ◽  
Tibial Stress Fracture

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: End-stage ankle arthritis is frequently treated with tibiotalar or tibio-talar-calcaneal (TTC) arthrodesis, whose sequelae include adjacent joint arthritis presumptively due to the increased stress inherent to the loss of a motion segment. The loss of ankle motion may also stress the distal tibia, and individual case reports exist describing tibial stress fracture after ankle arthrodesis. These case reports do not describe operative treatment however. The purpose of this study is to report a case series of patients who presented with a stress fracture of the tibia after ankle arthrodesis, a subsegment of whom failed nonoperative management, highlighting related risk factors and treatment strategies. Methods: The medical records at two large academic medical centers were reviewed retrospectively, from 1990 to 2017 at the first center and from 2013 to 2017 at the second center, to identify patients who had undergone ankle arthrodesis. Any patient who subsequently developed a stress fracture of the tibia, confirmed clinically and/or radiographically, was included in the subsequent analysis. Patients with a history of stress fracture prior to arthrodesis or with non-tibia stress fractures were excluded. Patient demographics were collected alongside surgical technique, duration of postoperative non-weight bearing status, presence of medical co-morbidities including osteoporosis and tobacco use, location of tibial stress fracture, and treatment strategy. Results: Twelve patients out of 988 (1.2%) developed tibial stress fracture. Seven patients underwent isolated ankle arthrodesis, four underwent ankle arthrodesis subsequent to subtalar fusion with a resultant ankle nonunion in two requiring revision TTC nailing, and one underwent primary TTC arthrodesis. Four patients had fibular osteotomy, and four had the lateral malleolus resected. The stress fracture was at the level of fibular osteotomy in two patients, and at the proximal end of existing or removed implant in six patients. All patients were treated initially with immobilization and activity modification except for one who had fracture displacement and underwent immediate plate fixation, and three who failed to improve with nonoperative treatment required fixation (two intramedullary nails, one plate). Conclusion: Tibial stress fractures can occur after an isolated ankle arthrodesis but is likely potentiated in the setting of previously or concomitantly fused subtalar joint. Transition points are especially at risk, either at the proximal end of an implant or at the proximal extent of a fibular osteotomy. Critically, stress fractures may present many years after ankle arthrodesis, with an average of four years in this series. In our series one third of patients necessitated surgical management, underscoring the importance of accurate diagnosis. Ultimately patients appear to do well with surgical repair even if they fail initial nonoperative treatment.

Stress fracture in a ceratopsian phalanx

1988 ◽  
Vol 62 (2) ◽  
pp. 302-303 ◽  
Author(s):  
Bruce M. Rothschild
Keyword(s):  
Fatigue Fracture ◽  
Stress Fracture ◽  
Fracture Stress ◽  
Stress Fractures ◽  
Periosteal Reaction ◽  
Stress Fatigue

A prominent anterior bulge on a ceratopsian dinosaur phalanx was examined for evidence of infection or stress (fatigue) fracture. The presence of a knife-slice type radiolucency, associated with periosteal reaction, was pathognomonic (diagnostic) for a stress fracture. Stress fractures have previously been recognized only in humans, racing greyhounds, and horses.

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