Stress fractures occur when normal bone is exposed to abnormal stress over time. They are common in military personnel and athletes. The document discusses stress fractures, defining them and covering their epidemiology, risk factors, pathophysiology, diagnosis and management. Key points: military service often links to stress fractures due to abrupt increases in training intensity; lower limb bones like the tibia are most commonly affected; overtraining, nutrition deficits and bone anatomy influence risk; MRI is a sensitive diagnostic tool; most stress fractures are managed non-operatively with rest, while displaced fractures may require surgery.
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Effects of ACL injuries on female performanceAmtulS24
Effect of ACL injuries on female performance which help to reduce chances of injuries on female and increase performance in physical activities and athletic events.
The role of Cement Augmentation in the Prevention of Spinal Insufficiency Fra...Winston Rennie
The Role of Cement Augmentation in the Prevention of Spinal Insufficiency Fractures. Spinal Vertebral fractures and percutaneous cement augmentation, vertebroplasty and kyphoplasty. The arguments for a role in preventing new spinal fractures and those against it. The flaws in experimental biomechanical studies and the importance of clinical spinal stability. Biplanar bipedicular percutaneous imaging approaches and formal trainig schemes to be established to train new practitioners with a biomechanically based cement placement.
Muscle tears are extremely common and are often recurrent. They are not as simple as we used to think and the advent of better imaging has proven that the site, size and location of the tear, together with the presence or otherwise of the tendon is crucial information especially for elite or professional athletes, who need accurate information about return to play. Traditional treatments of electrotherapy are simply placebos. The challenge ahead is to optimise treatments for the various diagnostic categories.
SPORTS INJURIES OF ANKLE AND FOOT original.pptxMeghaPrakash9
sports injuries of ankle and foot is a seminar done by Ms. Megha ck on behalf of completing her master of physiotherapy program during the year 2020-2022
Bobic Vladimir - ACL Injuries - Chester Uni MSc Sports Medicine 140324.pdfVladimir Bobic
Presentation for University of Chester MSc Sports Medicine Students. A review of knee ligament injuries, with emphasis on ACL injury, prevention, treatment and rehabilitation and inevitable PTOA in the long run.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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2. Introduction
• Military service and stress fractures are closely
linked.
• The first report of a stress fracture in the
literature was in 1855. Briethaupt, a Prussian
Army Physician recorded the painful swollen
feet of marching soldiers.
• In 1987, this condition was shown to be due
to a fractured metatarsal shaft and
subsequently termed a ‘march fracture’.
3. Definition
• Stress fractures occur when normal bone is
exposed to abnormal stress.
– They are seen in professional athletes and in
military personnel.
• Insufficiency fractures are fractures which
occur in abnormal bone when exposed to a
normal stress.
– They most commonly occur secondary to
untreated osteoporosis.
4. Epidemiology
• Since Briethaupt’s report, much of the published
literature on stress fractures relates to military
recruits because of the high incidence and because
they are an easy to study cohort of athletes.
• Studies reporting the incidence of stress fracture in
civilian athletes are probably much less accurate
than those reporting on military recruits because
they are a disparate group.
– Running athletes appear to have the highest incidence of
stress fractures.
5. Epidemiology
• The part of the skeleton at risk of
stress fracture clearly depends on the
activity undertaken.
• The vast majority of stress fractures
occur in the lower limb.
– Matheson et al reported that the tibia
was the most common site in civilian
athletes (49.1%), followed by the tarsals
(25.3%), metatarsals (8.8%) and femur
(7.2%).
• Stress fractures can occur in the
upper limb in throwing athletes and
rowers
Stress fracture of the proximal
tibia
6. Pathophysiology
• Bone is a dynamic tissue constantly
remodelling under the influence of multiple
hormonal and mechanical factors.
• There is a balance between bone resorption,
carried out by osteoclasts, and bone synthesis,
carried out by osteoblasts.
• Bone has a remodelling response to
mechanical stress so that the greatest amount
of bone is laid down in areas of greatest
applied stress (Wolff’s Law).
7. Pathophysiology
• When bone is subject to repetitive daily subthreshold loading,
microcracks may occur within cement lines: the normal
remodelling process repairs these cracks.
• However, if the bone continues to be subjected to high stresses
then crack propagation occurs.
• If crack propagation outstrips repair then over a period of time a
painful established stress fracture will develop.
• Given time, bone subjected to increased stress will lay down
more bone.
• It has been shown that during this process, osteoblastic activity
lags behind resorptive osteoclastic activity.
• Bone that is subject to a sudden increase in repetitive stress is
particularly vulnerable to stress fracture during this lag period.
• Military recruit training and poorly designed ‘get fit quick’ training
programs are examples of this phenomenon.
8. Risk factors
• Extrinsic risk factors
– Training regimen
– Training surface
• Intrinsic risk factors
– Bone anatomy
– Sex
– Nutrition
– Fitness
– Smoking
– Non-steroidal anti-
inflammatory drugs
• Risk factors for stress fractures are either extrinsic or intrinsic.
• Extrinsic factors pertain to the environment in which the
athlete trains and intrinsic factors pertain to the athlete.
9. Extrinsic Risk Factors
Training Regimen
• Activities with the highest loads for the most number of cycles
confer the highest risk of stress fracture such as long distance
running which has been shown to have an increased stress
fracture risk.
• Abrupt increases in training intensity without adequate rest
days also predisposes to stress fracture for a number of
reasons.
• As osteoblastic bone synthesis lags behind osteoclastic bone
resorption, hence there is period of decreased bone strength
following increased bone stress.
• If the athlete does not rest sufficiently to allow repair of the
cracks, then crack propagation occurs and an established stress
fracture can develop.
10. Extrinsic Risk Factors
Training Surface
• Load through the lower limb is related to the
ground reaction force.
• Running shoes should be replaced every 6
months, especially with cheaper EVA foam
shoes, as the foam compacts, losing shock
absorption, over time.
11. Intrinsic Risk Factors
Bone Anatomy
• The ability of a cylinder to resist bending and
torsional stress is proportional to the fourth
power of the cylinder radius.
– It follows that a wider long bone is stronger than a
thin long bone.
• Studies have demonstrated that small tibial
bone width, such as in females, correlates with
stress fracture risk.
12. Intrinsic Risk Factors
Sex
• Women are at increased risk of stress fracture
for a number of reasons.
– They have narrower bones and lower bone mineral
density.
– Women training for events where low body weight
is considered advantageous, such as gymnastics
and long distance running, are particularly at risk
from “ Female Athlete Triad” (disordered eating,
amenorrhoea, and osteoporosis).
13. Intrinsic Risk Factors
Nutrition
• Inadequate calcium and vitamin D intake may
increase the risk of stress fracture.
• Inadequate caloric intake is probably of greater
relevance in athletes, as dietary energy
restriction has been found to be accompanied
by reduced bone mass.
14. Intrinsic Risk Factors
Fitness
• A number of studies have demonstrated that
the aerobic fitness and previous sporting
experience of military recruits prior to starting
training are protective against stress fracture.
• This is likely to be because their skeleton is
better adapted to stress and because they
suffer less muscle fatigue.
15. Intrinsic Risk Factors
Smoking
• A survey of 915 female military recruits found
that those who smoked one or more cigarettes
in the year prior to commencement of basic
training were more likely to suffer a stress
fracture, with an increased relative risk of 2.2.
16. Intrinsic Risk Factors
NSAIDs
• There is theoretical evidence based on animal
studies that NSAIDs can have an adverse effect
on fracture healing.
• The evidence available regarding the effect in
humans is inconclusive.
– Until better quality evidence is available it is
reasonable to minimize the use of NSAIDs during
the management of stress fractures.
17.
18. Diagnosis
• Early diagnosis is important to minimize not
only time away from training but to preclude
non-union or a catastrophic displaced
fracture.
• Delay in diagnosis can lead to medical
discharge from the Services for military
personnel or early retirement from sport.
19. Diagnosis
History
• A thorough history should establish whether
the athlete has been exposed to any of the
risk factors discussed above; whether they
have undergone an abrupt increase in training
and in women whether they have had any
disruption of their menstrual cycle.
• Typically, the athlete describes an insidious
onset localized dull aching pain which is worse
with activity.
20. Diagnosis
Clinical Examinatiom
• On examination, the fracture site will normally be
tender and percussion of the bone at a site away from
the fracture may reproduce the pain.
• A high index of suspicion is necessary, especially for
femoral stress fractures which cannot be directly
palpated and frequently present with poorly localized
pain.
– Provocative tests such as pain on hopping can be helpful
when establishing a diagnosis of femoral stress fracture.
21. Diagnosis
Imaging
• Plain radiographs can be useful because they
are very specific and if a stress fracture is seen
then further imaging is rarely necessary.
– However, plain radiographs can be falsely
negative for up to 3 months after symptom onset.
– Early radiographs are often normal, with detection
rates as low as 15%, and serial radiographs are
diagnostic in only 50% of cases.
– Plain films generally reveal a range of relatively
late skeletal responses, from endosteal or
periosteal reactions to frank fractures.
22. The initial AP radiograph of the left foot in a patient with a
stress fracture of the 2nd
metatarsal, which appears normal.
A follow-up AP radiograph of the left foot in a patient with a stress
fracture of the 2nd
metatarsal, which shows a periosteal reaction (arrow)
23. Diagnosis
Imaging
• Isotope bone scans (scintigrams) are very
sensitive for stress fracture; however, it is not
specific.
– It detects the osteoblastic activity associated with
remodelling.
25. Diagnosis
Imaging
• MRI is able to depict abnormalities weeks
before a radiographic lesion.
• It has comparable sensitivity and superior
specificity with bone scintigraphy.
• It is extremely sensitive in the detection of
pathophysiological soft-tissue, bone and
marrow changes associated with stress
fractures and also demonstrates surrounding
muscular or ligamentous injury.
26. Diagnosis
Imaging
• The MR technique should include an oedema
sensitive sequence, such as a fat-suppressed
T2W or STIR (short tau inversion recovery)
images.
• A T1W image is better to define the anatomy
and more advanced fractures.
• Contrast imaging is not considered essential.
• The sensitivity of MR relies on its ability to
detect early bone marrow oedema, the
hallmark of the stress response.
27. Diagnosis
Imaging
• CT is less sensitive than scintigraphy or MRI in
the early detection of stress injury, but it is
more sensitive for the detection of cortical
fracture lines.
– It is therefore useful in demonstrating stress
fractures of the sacrum, pars interarticularis,
navicular and tibia.
28. Management
Non-operative
• The most important aspect of management is
early diagnosis.
• The vast majority of stress fractures can be
successfully treated non-operatively by
avoidance of the stressing activity.
• The general principles of non-operative
treatment are to avoid activity levels which
reproduce pain and a very gradual return to
training.
29. Management
Operative
• Most authors recommend operative
treatment for cases of delayed union or failed
non-operative treatment.
• The aims of surgical treatment are to improve
the mechanical environment for fracture
healing with a fixation device and/or improve
the biological environment with debridement
or bone graft.
31. Femoral Neck
• Femoral neck fractures constitute 8% of all
stress fractures in military personnel.
• As always, the key to management is
early diagnosis.
–The diagnosis should be considered in
any high risk patient with groin pain.
32. Femoral Neck
• Femoral neck fractures in
athletes usually occur in
the medial cortex which is
under compression.
– Undisplaced fractures are
stable and can be
successfully treated non-
operatively with an initial
period of non-
weightbearing.
– Displaced fractures should
always be reduced and
fixed surgically with large
cannulated screws.
33. Femoral Neck
• Stress fractures can affect the lateral cortex
which is subject to tensile forces, but this is
usually an insufficiency type fracture occurring
in older patients.
– These lateral stress fractures are associated with a
high risk of displacement and avascular necrosis of
the femoral head.
– Therefore, even undisplaced fractures of the
lateral cortex should normally be internally fixed.
34. Tibial Shaft
• Approximately 50% of all stress fractures in
runners and military recruits occur in the tibial
shaft.
• They can occur anywhere in the tibial shaft,
but most commonly affect the posteromedial
cortex.
• The majority can be successfully managed
non-operatively.
– The use of a pneumatic leg brace has been shown
to be helpful.
35. Tibial Shaft
• The less common stress fracture affecting the
anterior tibial cortex is more difficult to manage
because the incidence of delayed union is much
higher.
• This is probably because the anterior cortex is
subject to repetitive tensile rather than compressive
loading.
• Non-operative management will normally take at
least 6 months so early surgical management may be
an option.
– Borens et al report good results with anterior tension band
plating in a four high performance female athletes.
36. Metatarsals
• The metatarsals most
commonly affected by stress
fractures are the 2nd
and 3rd
–
the classic ‘march fracture.’
• These are prone to stress
fracture because they have a
thin shaft but are subject to
high levels of strain during the
propulsive phase of running.
• They usually do well with non-
operative management.
Stress fracture of the 3rd
MT with surrounding
tissue oedema
37. Navicular
• The majority of tarsal bone stress fractures occur in the
navicular.
• They are usually linearly orientated in the central third of the
navicular.
• They are often complicated by slow healing, delayed/non-
union, osteonecrosis and re-fracture.
• Nondisplaced and noncomminuted tarsal bone fractures may
be treated with conservative management with casting and
non-weight bearing for 6 weeks.
• Displaced or comminuted fractures are indications for surgical
intervention, which may include screw fixation or autologous
bone grafting, depending on the nature and age of the
fracture.
• Evaluation of footwear is important to prevent recurrence.
38. Metatarsals
• Stress fractures of the 5th
metatarsal typically
occur at the proximal junction of diaphysis and
metaphysis and have a higher incidence of
delayed and non-union.
39. Talus
• The classic pattern of a talus stress fracture is
linear bone marrow oedema perpendicular to
the trabecular flow, paralleling the
talonavicular articulation at the talar neck.
40. Calcaneus
• Stress injury of the
calcaneum is due to
axial compression
forces and is often
seen in jumpers.
• It most commonly
involves the dorsal
posterior aspect. Sagittal fat-saturated T2-weighted image
of the left ankle demonstrating a calcaneal
stress fracture. The hypointense fracture
line is seen surrounded by bone marrow
oedema (arrow).
41. Sacrum
• Sacral stress fractures are caused by vertical body forces from
the spine to the sacrum and then dissipated onto the sacral
ala.
• These may present as low back or buttock pain, mimicking
disk disease, sciatica, or sacroiliac joint pathology.
• These fractures more commonly affect the female runner.
• MRI is highly sensitive in the detection of early sacral
insufficiency fractures, but as diagnosis may be difficult, CT
and scintigraphy may also be required.
– Bone scan classically shows uptake paralleling the sacroiliac joints.
– CT may show linear sclerosis with cortical interruption.
– MRI may show linear signal alteration paralleling the sacroiliac joints.
43. Prevention
• Training intensity should be built up gradually with
rest periods built in to the regimen.
• Signs of stress fracture should be identified and
treated early.
• Female athletes and their trainers should be aware
of the high risk associated with menstrual
dysfunction.
• Diet should be optimized to avoid oligomenorrhoea.
• Early MRI scanning is the key to diagnosis, prognosis
and intervention.