scholarly journals Bilateral Sacral Stress Fracture in Pregnancy without Osteoporosis - A Case Report and Literature Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A185-A185
Author(s):  
Yu-Fang Wu ◽  
Kenneth Lu ◽  
Christian M Girgis ◽  
Martina Preda ◽  
Veronica Angela Preda
Keyword(s):  
Stress Fracture ◽  
Imaging Modality ◽  
Case Reports ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Lumbar Radiculopathy ◽  
Mineral Density ◽  
Normal Bone Mineral Density ◽  
Sacral Stress Fracture ◽  
In Pregnancy

Abstract Purpose: Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. Methods: A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included “stress fracture”, “postpartum”, “pregnancy”, “atraumatic” and the wildcard “sacr*”. 34 cases were found and summarised in Table 2. Results: 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. 70% of reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bedrest, analgesia and modified weight bearing exercises. Most patients have favourable outcome with complete symptom resolution. Conclusion: Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.

Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

2014 ◽  
Vol 7 (6) ◽  
pp. 515-521 ◽  
Author(s):  
Andrew R. Hsu ◽  
Simon Lee
Keyword(s):  
Computed Tomography ◽  
Stress Fracture ◽  
Guide Wire ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Functional Impairments ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

ULTRASONOGRAPHY AS A DIAGNOSTIC MODALITY OF TIBIAL STRESS FRACTURES

2008 ◽  
Vol 11 (02) ◽  
pp. 55-61 ◽  
Author(s):  
Uri Farkash ◽  
Javier Naftal ◽  
Estela Deranze ◽  
Alexander Blankstein
Keyword(s):  
Bone Scan ◽  
Imaging Modality ◽  
Case Reports ◽  
Stress Fractures ◽  
Surface Irregularity ◽  
Double Blind Study ◽  
Basic Training ◽  
Double Blind ◽  
Diagnostic Modality ◽  
Medicine Service

Tibial stress fractures (SFs) are a common orthopedic problem during military basic training. Bone scan is considered the gold standard for diagnosing this condition. Several case reports have described sonographic features of stress fractures. This is a prospective, double-blind study to compare diagnostic ultrasound (US) examination with isotope bone scan in diagnosing SF. Thirty-one soldiers who were referred to the nuclear medicine service for a bone scan to rule out tibial SF participated in this study. The SF lesions of the lower extremities were classified according to the classification criteria introduced by Zwas et al.20 US examination was performed on the same day. Areas of cortical thickening and other pathologies like bone surface irregularity and bone discontinuity were recorded. Each examination was graded as either normal or suggestive of representing a SF. Thirty of 62 tibiae were diagnosed as having SF according to bone scan, whereas US examination suggested SF in 35 tibiae. US examination was positive in 20 of 30 tibiae with SF (67% sensitivity, 53% specificity). Although US correctly diagnosed SF in 20 tibiae, bone scan remains the chosen imaging modality to detect SF in soldiers. US was not found to be a reliable modality to diagnose SF.

scholarly journals Postpartum Sacral Stress Fracture: An Atypical Case Report

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Andrea Speziali ◽  
Matteo Maria Tei ◽  
Giacomo Placella ◽  
Marco Chillemi ◽  
Giuliano Cerulli
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Cesarean Section ◽  
Stress Fracture ◽  
Sacral Fracture ◽  
Low Back ◽  
Mineral Density ◽  
Sacral Stress Fracture ◽  
Pregnancy And Lactation

Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

scholarly journals Swimmers Are At Risk For Stress Fractures? A Systematic Review

2018 ◽  
Vol 6 (3) ◽  
pp. 25 ◽  
Author(s):  
Angelo V. Vasiliadis ◽  
Vasileios Lampridis ◽  
Dimitrios Georgiannos ◽  
Ilias Bisbinas
Keyword(s):  
Systematic Review ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Sport Activity ◽  
Stress Fractures ◽  
Extrinsic Factors ◽  
Rare Type ◽  
Stress Injury ◽  
Competitive Swimming ◽  
Competitive Swimmers

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication.

scholarly journals 2 The incidence of undiagnosed coeliac disease in patients presenting with stress fracture to a tertiary referral centre

2019 ◽  
Vol 53 (13) ◽  
pp. 843.2-843
Author(s):  
R Smith ◽  
J Baldock ◽  
M FitzPatrick ◽  
N Jones ◽  
J Newton
Keyword(s):  
Coeliac Disease ◽  
Stress Fracture ◽  
Bone Fractures ◽  
Tissue Transglutaminase ◽  
Fracture Site ◽  
Stress Fractures ◽  
List Type ◽  
Mineral Density ◽  
Tertiary Referral Centre ◽  
Increased Risk

AimStress fracture aetiology is often multifactorial and laboratory blood tests (LBT) can unmask underlying metabolic bone risk factors and disorders. Coeliac disease (CD) is associated with low bone mineral density and an increased risk of fractures.1 In addition, there are rare reports of occult CD presenting with stress fractures.2 Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD and is used as a screening test.3 This report examines the incidence of undiagnosed CD in patients presenting with stress fractures to a Sport and Exercise Medicine (SEM) clinic.MethodsA retrospective analysis of 100 consecutive patients with radiologically proven stress fractures presenting to a single tertiary NHS SEM clinic was performed. Age, gender, fracture site, co-morbidities, TTG result and subsequent investigations were examined. Records were reviewed to confirm LBT, including TTG, had been performed at the time of diagnosis.ResultsSeventy patients (70%) were female and mean age was 37 years (range 18–69). Metatarsal (35%) and tibial (21%) fractures were most common. TTG was performed in 85 patients. Two patients were excluded due to pre-existing CD. Five patients (5/83 (6%), mean age 38 years (28–57), 80% female) had a positive TTG; three of whom had CD confirmed by endoscopic biopsy and two are awaiting investigation. Four patients with a positive TTG underwent dual energy X-ray absorptiometry, with osteopenia (T-Score between −1.0 and −2.5) found in 75% of cases, although only one had a Z-score less than -2.0.ConclusionIn this cohort, the incidence of undiagnosed CD was between 3.6% to 6%, with a prevalence between 5% to 7%, approximately 5-fold higher than UK population estimates. We recommend that TTG screening should be performed in all patients presenting with stress fractures to identify underlying CD. Further work is required to confirm this association and elucidate potential underlying mechanisms.ReferencesHeikkilä K, Pearce J, Mäki M, et al. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100(1):25–34.Gilbody J, Trevett M. Coeliac disease presenting with bilateral fibular stress fractures. Foot Ankle Surg 2009;15:96–100.3. Downey L, Houten R, Murch S, Longson D, Group GD. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 2015;351:h4513.

scholarly journals Stress fracture of the thoracic spine in a male rugby player: a case report

10.17159/4592 ◽  
2018 ◽  
Vol 30 (1) ◽  
pp. 1-2
Author(s):  
A Shafik
Keyword(s):  
Case Report ◽  
Stress Fracture ◽  
Thoracic Spine ◽  
Case Reports ◽  
Stress Fractures ◽  
Rugby Player ◽  
Anatomical Location ◽  
Anatomic Locations ◽  
Type Of Injury

This case reports a stress fracture of the thoracic spine in a professional rugby player. This is a rare anatomical location for this type of injury in this population and has not previously been described. Physicians should be aware that performance of rugby specific movements may lead to rare stress fractures in certain anatomic locations.

scholarly journals Not all ankle injuries are ankle sprains - Case of an isolated cuboid stress fracture

2018 ◽  
Author(s):  
Sidharth Unnithan ◽  
Joe Thomas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Left Ankle

A 22-year old lady, had a twisting injury to her left ankle followed by pain on prolonged weight bearing and walking. Magnetic resonance imaging with computed tomography correlation was done which showed an isolated cuboid stress fracture. Isolated cuboid stress fractures are very rare and are usually misdiagnosed as ankle sprains.

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