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Harvard Rotation > Bone Stress Injury (Tenforde article) > Flashcards

Bone Stress Injury (Tenforde article) Flashcards

1
Q

What are biologic risk fractures of BSI?

A 
Genetics
Medications
Calcium & Vitamin D def
Female athlete triad 
Female sex
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2
Q

What medications increase BSI risk?

A

Steroids
Anticonvulsants
Antidepressants
Antacids

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3
Q

What is the female athlete triad?

A 
Energy availability (eating disorder)
Menstrual function (amenorrhea)
Bone mineral density (osteoporosis)
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4
Q

What are biomechanical risk factors of BSI?

A 
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
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5
Q

What should be asked on history when evaluating BSI?

A 
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
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6
Q

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

A 
Focal tenderness
SI joint provovcation
Thigh thrust
Pelvic distraction/compression
FABER
Eval for leg length discrepancy
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7
Q

What maneuvers should be done to evaluate Femoral neck BSI?

A

Hip IR

FADIR (for FAI eval)

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8
Q

What maneuvers should be done to evaluate Lesser trochanter BSI?

A

Hip IR
FADIR (for FAI eval)
Iliopsoas tendonopathy

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9
Q

What maneuvers should be done to evaluate Femoral shaft BSI?

A

Fulcrum test to localize pain at injury site

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10
Q

What maneuvers should be done to evaluate Calcaneus BSI?

A

Calcaneal squeeze test

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11
Q

What are LOW risk anatomic locations of BSI?

A

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

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12
Q

What are MODERATE risk anatomic locations of BSI?

A 
Pelvis (sacrum and pubic rami)
Femoral shaft
Proximal tibia
Cuboid
Cuneiform
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13
Q

What are HIGH risk anatomic locations of BSI?

A 
Femoral neck
Patella
Anterior tibial diaphysis
Medial malleolus
Talus (lateral process)
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14
Q

What is a MRI Grade 1 for BSI?

A

Mild marrow or periosteal edema on T2; normal T1

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

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15
Q

What is a MRI Grade 2 for BSI?

A

Moderate marrow or periosteal edema plus + T2

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

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16
Q

What is a MRI Grade 3 for BSI?

A

Severe marrow or periosteal edema on T1 and T2

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

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17
Q

What is a MRI Grade 4 for BSI?

A

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
Q

Recommended intake of Vitamin D

A

Ages 9-70: 600 IU

>71: 800 IU

19
Q

Recommended intake of Ca

A

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

20
Q

What should be done for females with BSI?

A

Referral to Sports Dietitian

Ensure proper menstration

21
Q

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

A 
DEXA scan (using Z-scores)
Endocrine work up
22
Q

Tx for Tension side femoral neck fx

A

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
Q

Tx for femoral neck compression side and Lesser trochanter fx

A

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

24
Q

What is the dreaded black line?

A

Horizontal radiolucency localized to tension side of tibia

25
Q

Anterior Tibial cortex fx tx

A

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

26
Q

Medial malleolus fx tx

A

Initial trial of immobilization

Surgery for fx displacement or involvement of talocural joint

27
Q

Base of 2nd metatarsal fx tx

A

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

28
Q

What is a Morton’s toe?

A

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
Q

What is a Jone’s fx?

A

5th metatarsal diaphysis fx

High risk injury d/t avascularity of the bone distal to the tuberosisty which can result in nonunion

30
Q

Tx of a Jone’s fx tx

A

CAM walker boot

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

31
Q

Tarsal Navicular fx tx

A

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

32
Q

What can appear as a sesamoid fx on xray?

A

Bipartite sesamoid w/ sesamoiditis

Get xr-ray of asx foot to compare

33
Q

Tx of seasamoid fx

A

Delayed healing response

Cushioned orthosis w/ accomodative insole to offload

34
Q

Tx of sacrum & pelvis fx

A

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

35
Q

Tx of Cuboid & Cuneiform fx

A

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

36
Q

Tx of Femoral Shaft fx

A

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

37
Q

Tx of Tibia fx

A

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
Q

Tx of Fibula fx

A

Easy to exam due to surface bony anatomy

Prompt RTR when asx

39
Q

Tx of Calcaneus fx

A

Walking boot

Possibly crutches for pain-free mobility

40
Q

Tx of 2-4 metatarsal shaft fx

A

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

Harvard Rotation (3 decks)

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