Not-So-Run-of-the-Mill Running Injuries.

Abstract

Day and night, winter or summer, you see them out there—casual joggers, serious distance runners, and everyone in between. Among them are many fitness-minded orthopaedists, including our own ultra-marathoner, Tom Bauer, MD, Case Connector co-editor. It’s no surprise that these folks frequently experience overuse injuries related to the repetitive, rhythmic, deceleration impact forces that accompany running. Lower-extremity stress fractures, for instance, account for an estimated 16% of all injuries among runners. This month’s “Case Connections” sprints forward from an April 13, 2016, Case Connector report about a stubborn running-related stress fracture of the inferior pubic ramus that did not respond to the usually successful conservative approach. Okike and Moritz reported on a 51-year-old female runner whose symptoms from a stress fracture of the right inferior pubic ramus persisted after 11 months of nonoperative treatment. Pelvic radiographs made at the time of the initial presentation were read as negative, although a second review by the authors revealed a radiolucent line in the right inferior pubic ramus and a subsequent MRI four months later confirmed a stress fracture. By that time, the patient had stopped running but still had moderate to severe pain in the right posterior buttock area, which made walking and sitting for long periods problematic. The authors were able to reproduce the pain with palpation of the ischium posteriorly via the buttocks. Radiographs made at that time revealed callus formation in the inferior pubic ramus (Fig. 1), and a bone scan demonstrated focal increased uptake in the same location. Fig. 1 Radiograph showing callus formation at the site of a right inferior pubic ramus stress fracture. After 11 months of persistent symptoms, the patient opted for surgical fixation. Surgeons made an incision over the contralateral (left) superior pubic ramus and percutaneously placed a 115-mm-long 3.5-mm cortical screw across the right inferior …