Nonunion Of Stress Fracture Research Articles

Radial Head Stress Fracture Nonunion in Adolescent Overhead Athletes: A Case Series

Background: While osteochondritis dissecans of the humeral capitellum is well-described in adolescent overhead athletes, lateral compartment overload may also present with isolated radial head involvement. The primary goals of this study are to present a case series of radial head stress fracture nonunions in adolescent athletes and to provide guidelines regarding surgical indications and treatment. We hypothesize that surgical reduction and fixation of symptomatic lesions is safe, effective, and preserves the stability and articular congruity of the radiocapitellar joint.Methods: We retrospectively reviewed the clinical and radiographic records of nine patients presenting to a pediatric tertiary care center for radial head stress fracture nonunion from January 2008 to December 2016. Patient characteristics, presenting signs and symptoms, clinical and radiographic features, postoperative elbow motion, and radiographic healing were assessed.Results: Nine patients (five female; mean age 12.0 years [range 9.3-14.8 years] at time of injury) were treated for symptomatic radial head stress fracture nonunion. All patients reported persistent elbow pain with activities of daily living (ADLs) and athletics. Seven patients had limited elbow range of motion. Radiographically, the nonunion fragments comprised 20-45% of the radial head articular surface, and five patients had concomitant radial head subluxation. Five patients underwent open reduction internal fixation, one patient underwent microfracture and debridement, and one patient underwent intraarticular corrective osteotomy. All operative patients had improved or complete resolution of pain with ADLs. Additionally, all operative patients had either some increase in or complete regain of full elbow range of motion. Progressive or complete radiographic healing was seen at a median of 14 weeks postoperatively.Conclusions: In this case series, skeletally immature athletes with radial head stress fracture nonunions experienced pain relief, maintained or improved motion, and radiographic bony union following surgical intervention. Radiocapitellar joint stability and congruity were preserved or restored.Level of Evidence: Case series; Level IV Key Concepts•With increased participation in overhead and/or throwing sports, repetitive valgus stress on the elbow may lead to lateral compartment overload injuries.•While osteochondritis dissecans (OCD) of the capitellum is well-characterized, isolated radial head stress injuries may also occur.•Surgical treatment for symptomatic or displaced radial head stress injuries may provide pain relief, bony healing, improved range of motion, and return to sports.•Patients, families, and providers should be aware of this clinical condition, and surgical treatment should be considered in cases of persistent pain, bony nonunion, displacement, joint instability and/or incongruity.

Standalone Photodynamic Intramedullary Implants in the Treatment of Bilateral Refractory Femoral Nonunions in a Patient with Osteogenesis Imperfecta: Significant Utility in Load-Bearing Bones, But Not a Replacement for Biomechanical Optimization

A photodynamic implant is a useful modality for stabilizing intrinsically weak or osteoporotic bone defects or fractures in select patients. Advantages of these implants are their minimally invasive nature, quick annealing, and flexible accommodation of bowed medullary canals. We have determined experientially that these implants can be used successfully in the long bones of the lower extremity, even in patients with pathologic bone stock. However, creation of the appropriate biomechanical conditions for fracture healing is critical to technical success. This is evidenced in our experience managing a 30-year-old active male with osteogenesis imperfecta , who presented with chronic pain and disability after failing conventional intramedullary nailing of his left femur. He presented with distal implant cut-out and a mid-shaft stress fracture nonunion . He underwent implant removal and intramedullary stabilization using 3 photodynamic intramedullary implants. The patient healed uneventfully, returned to full weightbearing and work 1 month after surgery, and was asymptomatic 18 months postoperatively. At this time he complained of similar pain on his right side, and implant cutout and a nonunion at the apex of a large varus deformity of the subtrochanteric area of his hip was noted. A similar 3-implant photodynamic nailing was performed, but the patient began to complain of groin pain 1 month after surgery, and 2 months postoperatively was unable to weightbear. It was found that he had fractured through the nonunion. Plate fixation with deformity correction was performed, after which the patient healed uneventfully and is now being advanced to full weight bearing.

Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report

BackgroundLeg pain in athletes is a common condition and is often related to tibial stress fracture. When non-operative treatment fails, the optimal surgical treatment is controversial. The aim of this study was to report a case of tension band plating of an anterior tibial stress fracture nonunion, treated previously with intramedullary nailing. To the best of our knowledge, this is the first reported case in which tension band plating was placed without removing the preexisting intramedullary nail.Case presentationThe tibial shaft is a common location of stress fracture in athletes. Anterior tibial stress fractures are difficult to manage. When conservative treatment fails, intramedullary nailing is the mainstay of treatment. However, nonunion is a serious complication. In our case, a non-united anterior tibial stress fracture, treated with intramedullary nailing, was addressed with the application of a compression prebended plate over the nail in a 23-year-old French man of African origin who is an elite football player. At 3-months postoperatively he was pain free and started light exercises. At 6-months postoperatively, complete radiologic union of the fracture was evident. He was symptom free; he resumed at that time a full training program and he returned to play football at preinjury high competition level.ConclusionsCompression plating is a valuable method of treating non-united anterior tibial stress fractures. We believe that anterior tension band plating is superior to intramedullary nailing in managing anterior tibial stress fractures, not only after failure of intramedullary nailing, but also as a first-line surgical treatment. This technique offers advantages, such as no violation of the extensor mechanism and risk of anterior knee pain, and directly addresses the underlying problem of distraction forces acting on the anterior tibial cortex and compromising fracture healing. Especially in high-level athletes, who cannot tolerate prolonged inactivity, early surgical intervention of anterior tibial stress fractures with tension band plating is a reliable option that can accelerate recovery.

Supracondylar femur fracture repair using IlluminOss in a patient with Osteogenesis Imperfecta type 4

A photodynamic implant is a useful modality for stabilizing intrinsically weak or osteoporotic bone defects or fractures in select patients. Advantages of these implants are their minimally invasive nature, quick annealing, and flexible accommodation of bowed medullary canals. We have determined experientially that these implants can be used successfully in the long bones of the lower extremity, even in patients with pathologic bone stock. However, creation of the appropriate biomechanical conditions for fracture healing is critical to technical success. This is evidenced in our experience managing a 30-year-old active male with osteogenesis imperfecta, who presented with chronic pain and disability after failing conventional intramedullary nailing of his left femur. He presented with distal implant cut-out and a mid-shaft stress fracture nonunion. He underwent implant removal and intramedullary stabilization using 3 photodynamic intramedullary implants. The patient healed uneventfully, returned to full weightbearing and work 1 month after surgery, and was asymptomatic 18 months postoperatively. At this time he complained of similar pain on his right side, and implant cutout and a nonunion at the apex of a large varus deformity of the subtrochanteric area of his hip was noted. A similar 3-implant photodynamic nailing was performed, but the patient began to complain of groin pain 1 month after surgery, and 2 months postoperatively was unable to weightbear. It was found that he had fractured through the nonunion. Plate fixation with deformity correction was performed, after which the patient healed uneventfully and is now being advanced to full weight bearing.

Minimally Invasive Screw Fixation of Inferior Pubic Ramus Stress Fracture Nonunion in a Runner: A Case Report.

A fifty-one-year-old female runner developed a stress fracture of the inferior pubic ramus. Nonoperative treatment was initiated, but the symptoms persisted and she was diagnosed with a nonunion. After eleven months of symptoms and ten months of nonoperative treatment, including four months of complete avoidance of running, percutaneous screw fixation was performed, with radiographic and clinical healing of the fracture. While inferior pubic ramus stress fractures are usually successfully treated nonoperatively, instances of nonunion and delayed union have been described. In the present report, we describe the case of a patient in whom an inferior pubic ramus stress fracture nonunion was successfully treated with minimally invasive screw fixation.

Superficial Peroneal Neuropathy after Surgical Intervention: A Case Report

Superficial Peroneal Neuropathy after Surgical Intervention: A Case Report True neuropathies are rare in young, active athletes. However, following invasive treatments and surgeries damage to neurovascular structures, particularly those that are superficial, may occur. This case was complicated by continued tenderness subsequent to a navicular fracture, which masked the neurogenic signs and symptoms related to superficial peroneal neuromas. This report presents the case of an iatrogenic injury leading to the development of neuromas in the superficial peroneal nerve following several surgical interventions for a navicular stress fracture. A 20-year-old female collegiate soccer player, with a previous history of foot injury, was diagnosed with a navicular stress fracture. She underwent ORIF with bone grafting to repair non-union of stress fracture. During normal rehabilitation progression, the patient developed anterolateral ankle pain.

Cannulated Screw Delivery of Bone Marrow Aspirate Concentrate to a Stress Fracture Nonunion

Cannulated Screw Delivery of Bone Marrow Aspirate Concentrate to a Stress Fracture Nonunion

Ulnar collateral ligament tear and olecranon stress fracture nonunion in a collegiate pitcher

Ulnar collateral ligament tear and olecranon stress fracture nonunion in a collegiate pitcher

Surgical Management of Proximal Fourth Metatarsal Stress Fracture Nonunion: Debridement and Locking Plate Stabilization

Although fractures of the proximal fourth metatarsal are rare, when they occur they may be associated with prolonged healing and increased rates of nonunion. We report a case of fourth metatarsal nonunion and describe the technique of debridement of the nonunion site and locking plate stabilization. This technique allows fracture stabilization and optimizes periosteal vascularization of the fracture site, thus promoting healing. We recommend this technique for the debridement and stabilization of marginal proximal metatarsal fractures with established nonunion.

Shin Pain - Running

HISTORY A 51 year old man with a four year history of celiac disease presented with shin pain. After putting on weight with his gluten-free diet, he had commenced running and had recently completed a half marathon. Since the race he had shin pain every time he ran. He had been diagnosed with a stress fracture of the tibia and rested from running for two months. When he resumed running the pain was still present. PHYSICAL EXAMINATION He was tender to palpation over the anterior aspect of the tibia. There were no obvious biomechanical abnormalities. DIFFERENTIAL DIAGNOSIS Stress fracture tibia Stress fracture anterior cortex tibia TEST AND RESULTS X Ray lower leg cortical thickening of the antero-lateral aspect of the lower tibial shaft with a faint transverse linear lucency through the thickened cortex DEXA bone density scan Lumbar spine 1.052 gm/sq cm (T score: −1.6), femoral neck 0.835 gm/sq cm (T score: −1.8). Vit D level - lower end of normal range PTH - high Serum calcium - normal FINAL WORKING DIAGNOSIS Non-union of stress fracture of the anterior cortex of the tibia secondary to osteopenia due to the Vitamin D malabsorption associated with celiac disease TREATMENT AND OUTCOMES Vitamin D 1000 units/day Surgery to scallop out the area of non-union of the stress fracture of the tibia

Shin Pain - Running

HISTORY A 51 year old man with a four year history of celiac disease presented with shin pain. After putting on weight with his gluten-free diet, he had commenced running and had recently completed a half marathon. Since the race he had shin pain every time he ran. He had been diagnosed with a stress fracture of the tibia and rested from running for two months. When he resumed running the pain was still present. PHYSICAL EXAMINATION He was tender to palpation over the anterior aspect of the tibia. There were no obvious biomechanical abnormalities. DIFFERENTIAL DIAGNOSIS Stress fracture tibia Stress fracture anterior cortex tibia TEST AND RESULTS X Ray lower leg cortical thickening of the antero-lateral aspect of the lower tibial shaft with a faint transverse linear lucency through the thickened cortex DEXA bone density scan Lumbar spine 1.052 gm/sq cm (T score: −1.6), femoral neck 0.835 gm/sq cm (T score: −1.8). Vit D level - lower end of normal range PTH - high Serum calcium - normal FINAL WORKING DIAGNOSIS Non-union of stress fracture of the anterior cortex of the tibia secondary to osteopenia due to the Vitamin D malabsorption associated with celiac disease TREATMENT AND OUTCOMES Vitamin D 1000 units/day Surgery to scallop out the area of non-union of the stress fracture of the tibia

Symptomatic non-union of second metatarsal stress fracture following talo-navicular arthrodesis

Abstract Stress fractures of the second metatarsal are well reported, and usually heal spontaneously after identifying the aetiology and modifying activity. A unique case of non-union of stress fracture of the second metatarsal following talonavicular arthrodesis for Mueller–Weiss syndrome is presented here. A 34-year old male was presented with forefoot pain 18 months post a talo-navicular arthrodesis for Muller–Weiss syndrome. The foot was swollen and tender over the second metatarsal. Radiographs revealed diaphyseal cortical thickening, and a diaphyseal fracture of the second metatarsal. Conservative treatment failed to achieve union. DEXA scan showed normal bone density, CT scan confirmed non-union. The metatarsal non-union was subsequently freshened, bone grafted and fixed with a small fragment plate; union was achieved at 8 weeks post-operatively. A second metatarsal stress fracture non-union secondary to altered mechanics in the foot as a result of talo-navicular arthrodesis is presented here with a literature review.

Nonunion of Stress Fracture of Femoral Neck in a Child Managed with Valgus Osteotomy

Stress fracture of the femoral neck is very rare in children with an open upper femoral physis. There are only a few cases reported in the literature with most of these fatigue fractures of femoral neck managed conservatively. Some fractures require internal fixation either for displacement or for nonunion. A 7-year-old girl with a fatigue fracture of the femoral neck is presented, which resulted in coxa vara and functional disability. She was managed with valgus osteotomy and internal fixation using a dynamic hip screw. This resulted in union of the fracture site with good functional outcome.

Stress Fracture Nonunion at the Base of the Second Metatarsal in a Ballet Dancer

Stress Fracture Nonunion at the Base of the Second Metatarsal in a Ballet Dancer

Operation for non-union of stress fracture of the tarsal navicular.

Stress fractures of the tarsal navicular do not heal predictably with conservative treatment, so we recommend operation if the fracture remains symptomatic, and radiographs show wide separation of a complete fracture, extension of an incomplete fracture, delayed healing, or a medullary cyst. An autologous bone graft is inserted after en-bloc resection of the fracture surfaces. It is important that the fracture is fully exposed to its distal limits before the graft is inserted. We have grafted 19 fractures in 18 patients. Six fractures were complete, 12 incomplete and one had a residual medullary cyst. Of the 15 patients with adequate follow-up, 12 had been able to return to a pre-injury level of activity by five to 12 months.