Initial Management Decision - Referral

Question 1

Describe stress fractures:

• MOI
• Where do you see them?
• PE findings?
• Imaging?

Answer 1

MOI
- recent change in training, female gender, eating disorders

Where?
- areas of poor blood supply that sustain high stress (navicular, anterior tibia, metatarsal)

Findings:

• point tenderness
• pain with percussion away from fracture site
• hopping on one leg

Imaging:
- CT/MRI/bone scan - sometimes hard to see anything on imaging esp with XR - so marry it with the history!

Question 2

Describe the continuum of bone stress and when you’d see findings on imaging

Answer 2

Silent stress reaction - stress reaction - stress fracture

- you’d have CT/MRI findings after stress reaction

Question 3

Briefly describe the 4 stagings of cancer

Answer 3

Stage 1 - cancer is small and contained within the organ is originated in

Stage 2 - cancer is larger but not yet spread into surrounding tissue; may have spread into lymph nodes surrounding the tumor

Stage 3 - cancer is larger and has spread into surrounding tissues + cancer cells in the lymph nodes

Stage 4 - cancer has spread to another body organ - metastatic cancer

Question 4

Describe ENCHONDROMA

Answer 4

• benign
• cartilage growing where there should be bone
• bone absorption, swelling, pathological fracture
• common in foot+hand
• Tx = nothing if asymptomatic; resection/bone grafting if it breaks

Question 5

Describe OSTEOSARCOMA

Answer 5

• MALIGNANT
• in metaphysis
• mainly in adolescents
• very aggressive - mets into lungs so early Dx is crucial
• Tx - chemo, gene therapy, resection

Question 6

Describe CHONDROSARCOMA

Answer 6

• MALIGNANT
• mainly in adults > 30
• Tx - resection usually has good result