Stress fractures were first described by Briethaupt in 1855. Since then, there have been many discussions in the literature concerning stress fractures, which have been described in both weight-bearing and non-weight-bearing bones. Currently, the tibia is the most frequent location, but multiple stress fractures in the same tibia are rare. This paper presents an unusual case of a 60-year-old woman with multiple tibial stress fractures of spontaneous onset.Keywords stress fracture, tibia, multiple, aged population Case ReportA 60-year-old woman was seen and followed at our department for right leg pain. The medical history of this woman included multiple depression episodes, resection of a benign left breast cancer tumor, morbus Parkinson, thyroid dysfunction after intake of lithium, and rib fractures after a fall. Her medication chart mentioned an antidepressant (imipramine), analgetics (paracetamol and tramadol), her Parkinson medication (prolopa and levodopa), and a sleeping tablet (lormetazepam).Her initial symptoms of lower right leg pain with associated redness of the overlying skin were experienced since June 2005. She first consulted the department of neurology, where she was admitted for further investigation. An ultrasound was helpful to exclude deep-venous thrombosis. Radiographic images confirmed the absence of any osseous pathology. Empiric antibiotics (amoxicillin) for possible erysipelas were commenced, without any result. Evoked potentials as well as EMG were normal. Laboratory analyses showed slightly elevated LDH but normal CRP and sedimentation rates, normal calcium levels and alkaline phosphatise, and normal vitamin D and PTH levels. Kidney and liver functions were also within normal range. Discharge with NSAIDs and observation.Fourteen days after discharge, the patient was readmitted with immense pain, inability to walk, mild swelling of her lower leg, and redness. Ultrasound showed some edema in the lower leg, while radiography revealed slight periosteal reaction on the dorsal side of the distal tibial metaphysis (Figure 1). Magnetic resonance imaging (MRI) confirmed the edema of the distal half of the tibia with concomitant inflammation of the surrounding soft tissue (arrow). Additionally, the MRI showed a fracture line in the distal tibia (arrowhead; Figure 2). All the above-mentioned signs and findings were in favor of a stress fracture (insufficiency fracture); however, infection or any malignant pathology still had to be ruled out. To complete the technical investigation, a bone scan was performed. Hyperemia of the middle and distal tibia suggestive of osseous pathology was found, no evidence of malignancy, however indicative for stress fracture versus osteomyelitis (Figures 3 and 4). The latter was ruled out by a leucocyte scan and renewal of laboratory analysis, which were normal and comparative to previous results. The diagnosis of insufficiency fracture at multiple sites of the same tibia was determined, despite no evidence of trauma or raised activity level of any kind. Tr...
Myositis ossificans is a rare condition characterized by non-neoplastic heterotopic bone formation in soft tissue and skeletal muscle. It is a benign and often self-limiting disease with no need for surgery. Here, we describe a young female swimmer with myositis ossificans circumscripta of the triceps due to overuse. Because of the benign character of the lesion, conservative treatment was initiated with rest and anti-inflammatory drugs. She obtained complete resolution after 6 months and was able to return to normal sporting activities. Myositis ossificans circumscripta is a rare benign lesion with an excellent prognosis. Most lesions in athletes occur due to contusions or strains; however, overuse is now described as well. Spontaneous resolution is seen in almost all cases. Cases in which, despite conservative treatment, a painful mass persists, surgical excision can be considered.
This is the first study to determine the normal 3D relationship between the humerus and the glenoid (°GH). This new three-dimensional anatomical information of the normal glenohumeral relationship and glenoid can be used to distinguish normal from pathological anatomy, as well as alternative surgical guidance especially in bony deficient glenoids. Level of Evidence Level II Anatomical Study.
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