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.

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.

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 Risk factors for adhesive capsulitis requiring shoulder arthroscopy: A clinical retrospective case series study

2020 ◽  
Vol 19 ◽  
pp. 14-16
Author(s):  
Ryan S. Selley ◽  
Daniel J. Johnson ◽  
Richard W. Nicolay ◽  
Ksheeraja Ravi ◽  
Cort D. Lawton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Arthroscopy ◽  
Adhesive Capsulitis ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Case Series Study ◽  
Series Study

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 Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series

Scoliosis ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Cameron Barton ◽  
Andriy Noshchenko ◽  
Vikas Patel ◽  
Christopher Cain ◽  
Christopher Kleck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Posterior Correction ◽  
Rod Fracture

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 Intramedullary Fixation of Distal Fibula Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0047
Author(s):  
Benjamin D. Umbel ◽  
B. Dale Sharpe ◽  
Terrence M. Philbin
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Ankle Fractures ◽  
Fracture Union ◽  
Retrospective Case ◽  
Distal Fibula ◽  
Percutaneous Reduction ◽  
Retrospective Case Series ◽  
Intramedullary Device ◽  
Additional Surgery

Category: Ankle; Trauma Introduction/Purpose: For unstable ankle fractures, surgeons typically employ the long-time standard of care; that is, open reduction and internal fixation with plate and screws. For patients with increased risk of soft tissue complications, a relatively newer construct includes intramedullary distal fibula fixation offering a viable option providing similar union rates, fracture alignment, and theoretical lower infection rate. Our study examines an intramedullary system with a novel design featuring fixation by proximal talons ensuring maintenance of alignment, rotation, and prevention of fracture settling. Our research builds on recent published work evaluating this intramedullary device. However, our study is the largest case-series, to our knowledge to assess time to weightbearing, fracture union and union rate as well as the first to assess safety and reproducibility of percutaneous reduction. Methods: A retrospective case-series was conducted on all skeletally mature patients with unstable ankle fractures treated with the same intramedullary distal fibular fixation. Surgeries were performed by a single surgeon between September 2015 and August 2019. Patient post-operative imaging was carefully assessed for quality of reduction, classifying reductions as ‘good,’ ‘acceptable,’ or ‘poor,’ also assessing for union and fracture settling. Patient charts were also assessed for comorbidities, injury pattern, fracture classification, associated injuries, fracture reduction method, perioperative complications, tourniquet time, characteristics of fracture union, time to weight bearing, and need for additional surgery. Results: Fifty-one patients were included in the study. Mean follow-up time was 32.2 weeks. Four fractures were bimalleolar (7.8%), 44 were isolated distal fibula fractures (86.3%), and 3 were trimalleolar fractures (5.9%). Two percent were Weber A, 77% Weber B, and 11% Weber C. Thirty-five (69%) reductions were achieved closed or percutaneously without complications. Based on reduction classification system, 47 fracture reductions (92%) were classified as ‘good’ and 4 (8%) were ‘acceptable’. All but one fracture (98%) went on to union. Average time to union was 10.3 weeks. Average weightbearing in a walking boot was at 6.8 weeks and 11.2 weeks without immobilization. One patient (2%) had a superficial wound infection, and there were no deep infections. Diabetes, smoking, and neuropathy were not predictive of complications. Conclusion: Our study strengthens the growing body of evidence supporting the safety and efficacy for a novel intramedullary device with unique proximal fixation. To our knowledge, this is currently the largest retrospective case-series in the literature evaluating this device. Fracture union and union rates were found to be acceptable for unstable ankle fracture patterns and infections rates were found to be very low, consistent with previous research. Percutaneous reduction of the lateral malleolus did not result in any injury to nearby anatomic structures or unsatisfactory fracture alignment. Lastly, consistent time to weight bearing following surgery could safely be achieved without consequence.

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