Bone Stress Injury (Tenforde article) Flashcards Preview

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Flashcards in Bone Stress Injury (Tenforde article) Deck (40):
1

What are biologic risk fractures of BSI?

Genetics
Medications
Calcium & Vitamin D def
Female athlete triad
Female sex

2

What medications increase BSI risk?

Steroids
Anticonvulsants
Antidepressants
Antacids

3

What is the female athlete triad?

Energy availability (eating disorder)
Menstrual function (amenorrhea)
Bone mineral density (osteoporosis)

4

What are biomechanical risk factors of BSI?

Training patterns (volume or intensity)
Bone char (thinner cortex, lower BMD)
Leg length discrepancy
Lean Mass
Cavus or planus foot type
Smaller calf cross-sectional area
Higher peak hip ADD
Knee IR
Knee ABD
Tibial IR
Rear foot eversion
Running >20 miles/week

5

What should be asked on history when evaluating BSI?

complete running hx
Freq of racing
Changes in running volume
Shoe type and duration of use
Change in foot strike pattern
Dietary restriction behavior
Foods high in vit D & Ca
Medications (hormones, steroids)
Personal or family hx of Low BMD

6

What maneuvers should be done to evaluate sacral/pelvic BSI?

Focal tenderness
SI joint provovcation
Thigh thrust
Pelvic distraction/compression
FABER
Eval for leg length discrepancy

7

What maneuvers should be done to evaluate Femoral neck BSI?

Hip IR
FADIR (for FAI eval)

8

What maneuvers should be done to evaluate Lesser trochanter BSI?

Hip IR
FADIR (for FAI eval)
Iliopsoas tendonopathy

9

What maneuvers should be done to evaluate Femoral shaft BSI?

Fulcrum test to localize pain at injury site

10

What maneuvers should be done to evaluate Calcaneus BSI?

Calcaneal squeeze test

11

What are LOW risk anatomic locations of BSI?

Posteriomedial tibia
Fibula/lateral malleolus
Calcaneus
Diaphysis of 2nd-4th metatarsals

12

What are MODERATE risk anatomic locations of BSI?

Pelvis (sacrum and pubic rami)
Femoral shaft
Proximal tibia
Cuboid
Cuneiform

13

What are HIGH risk anatomic locations of BSI?

Femoral neck
Patella
Anterior tibial diaphysis
Medial malleolus
Talus (lateral process)

14

What is a MRI Grade 1 for BSI?

Mild marrow or periosteal edema on T2; normal T1

Mild to moderate periosteal edema on T2; Normal marrow on T2 and T1

15

What is a MRI Grade 2 for BSI?

Moderate marrow or periosteal edema plus + T2

Moderate to severe periosteal edema on T2; Marrow edema on T2 but not T1

16

What is a MRI Grade 3 for BSI?

Severe marrow or periosteal edema on T1 and T2

Moderate to severe periosteal edema on T2; Marrow edema on T2 and T1

17

What is a MRI Grade 4 for BSI?

Severe marrow or periosteal edema on T1 and T2 plus fx line on T1 or T2

Moderate to severe periosteal edema on T2; Marrow edema on T2 and T1; fx line present

18

Recommended intake of Vitamin D

Ages 9-70: 600 IU
>71: 800 IU

19

Recommended intake of Ca

Ages 9-18: 1300 mg
Women 19-50 yo & Men 19-70 yo: 1000 mg
Women >51 yo & Men >71 yo: 1200 mg

20

What should be done for females with BSI?

Referral to Sports Dietitian
Ensure proper menstration

21

What should be done for males with BSI in pelvis, sacrum or femoral neck?

DEXA scan (using Z-scores)
Endocrine work up

22

Tx for Tension side femoral neck fx

Bed rest if no widening of cortical fx
Ortho referral for failure to achieve interval bony healing
Cross-training exercises when pain free
2-3 mo to heal

23

Tx for femoral neck compression side and Lesser trochanter fx

NWB on crutches
Repeat imaging to ensure bone healing
Cross-training exercises when pain free
2-3 mo to heal

24

What is the dreaded black line?

Horizontal radiolucency localized to tension side of tibia

25

Anterior Tibial cortex fx tx

Assess for "dreaded black line"
Repeat imaging to ensure bone healing prior to WB
IM rod for nonunion

26

Medial malleolus fx tx

Initial trial of immobilization
Surgery for fx displacement or involvement of talocural joint

27

Base of 2nd metatarsal fx tx

High risk, esp if Lisfranc join (metatarsal-cuneifrom) involved
Min 4 wks immobilization
Repeat x-ray & exam to ensure pain free before WB

28

What is a Morton's toe?

2nd toe extending past the great toe
RF for 2nd metatarsal fx d/t inc force through 2nd ray of foot
Custom foot orthosis w/ metatarsal pad beneath 2nd metatarsal to dec risk

29

What is a Jone's fx?

5th metatarsal diaphysis fx
High risk injury d/t avascularity of the bone distal to the tuberosisty which can result in nonunion

30

Tx of a Jone's fx tx

CAM walker boot
Surgery: IM screw fixation & bone grafting l/t RTP in 12 wks

31

Tarsal Navicular fx tx

Strict NWB
CT to assess for healing in chronic process
Surgery: high grade, AVN, cystic changes or sclerosis

32

What can appear as a sesamoid fx on xray?

Bipartite sesamoid w/ sesamoiditis
Get xr-ray of asx foot to compare

33

Tx of seasamoid fx

Delayed healing response
Cushioned orthosis w/ accomodative insole to offload

34

Tx of sacrum & pelvis fx

Crutches to NWB
WB when ambulation pain free
RTFA in 12 weeks

35

Tx of Cuboid & Cuneiform fx

Immobilization for pain free ambulation
Progression to neutral shoe
PT for strength & biomechanical factors

36

Tx of Femoral Shaft fx

Injuries w/o displacement or cortical break heal & RTR in 8-12 wks

37

Tx of Tibia fx

Injuries typically at distal 1/3 posterior medial aspect
more severe: focal pain, tenderness with direct/indirect palpation
MRI grade prognosticates for recovery in 3-12 wks

38

Tx of Fibula fx

Easy to exam due to surface bony anatomy
Prompt RTR when asx

39

Tx of Calcaneus fx

Walking boot
Possibly crutches for pain-free mobility

40

Tx of 2-4 metatarsal shaft fx

Low risk & good response to healing
No fx line: metatarsal pad w/ firm shoe to ambulate w/o pain
Fx line: repeat x-rays in 4 wks to ensure healing
Cross train 7 RTR progression when ambulating pain free
6-8 wks RTR