Broken Talus More Likely to Breat Again
Fractures Without Meaning Trauma
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The circumstance of fracture without whatsoever history of significant trauma is not uncommon. Whenever you get this history, a cherry flag should popular up in your visual cortex and a bell should go off in your auditory tracts.
Mostly, the differential diagnosis hither is fairly logical. The thing to think is that a bone needs a reason to interruption. Usually, that reason is that a substantial force has been practical to the bone. If there is no evidence of such a force, we must wait for some other reason. To practise this, you lot must commencement respond ii questions: 1) did the fracture occur through normal or abnormal bone; 2) is at that place normal or decreased amount of bone present? One time you lot have answered these two questions, you can use the following handy-neat flowchart to get in at the most probable machinery for the fracture.
Fractures through abnormal bone are chosen "pathological" fractures. Probably the well-nigh common crusade of this is an underlying tumor, either benign or cancerous. However, near whatever underlying procedure of os that weakens the bone can atomic number 82 to a pathological fracture. Therefore, one should likewise consider infection, osteomalacia, and Paget's illness, amongst other causes.
When there is normal bone but just non enough of information technology, we call it osteoporosis. This is by far the most common reason for a fracture without meaning trauma.
Osteoporosis lies in await for every living human, if only they alive long plenty to develop information technology. This is specially truthful of postmenopausal women, who may lose upwards to xx % of their bone mass in a year in extreme cases. Other risk factors for osteoporosis include Caucasian heritage, smoking, lack of antigravity practise, low dietary calcium intake, and various amenorrheic states.
Now, how do you go nearly diagnosing osteoporosis? Well, if it is early osteoporosis, looking at radiographs won't help you much, because evidently films are hideously insensitive to osteopenia. In order to see a lesion in bone, an estimated 30 to 50 % of the bone must first be lost. If the osteoporosis is really bad, the bones may look washed out, and simply the primary weight-bearing trabeculae may exist visible. If less that 30 – 50 % of the bone is gone, then yous may take problem being certain that osteoporosis exists at all.
To definitively diagnose osteoporosis, one must perform some type of quantitative imaging study on the os in question. The current state of the fine art in quantitative bone assessment is dual energy X-ray absorptiometry (DEXA). This is washed with a dedicated device virtually the size of a conventional radiographic examination tabular array. A scanning arm then passes over the patient and scans the area of interest. As this scanning arm moves about, a axle of X-rays at primarily two different energies are transmitted through the patient, and their respective amounts of absorption by the tissues of the patient's trunk are measured by a sensing probe on the other side of the patient. If a patient has more bone, then less X-rays brand information technology through the patient into the X-ray detector. If less bone is present, then more than 10-rays make it through. A estimator attached to the device and so takes this information, and uses it to create a transmission image of the bones of interest, and then compares this information with normative standards so that one can decide if the patient indeed has osteoporosis.
With chronic repetitive stress, 1 tin can interruption whatsoever bone in the torso. Still, this is more likely in certain bones, such as the tibial shaft, the metatarsal shafts, the femur, and the basic of the pelvis. If the fracture is fairly new, then in that location may be no obviously pic prove of it. Later, in one case the fracture has been around long enough, periosteal reaction is frequently seen adjacent to the fracture site. A radionuclide bone scan or MRI tin be used to screen for stress fractures. The bone scan volition evidence a stress fracture as an expanse of increased uptake of tracer, while MRI will prove focal or diffuse marrow edema at the fracture site.
The main reason prompting the early diagnosis of stress fracture is so that the patient tin can exist advised to remainder the affected part. If the affected role continues to be loaded sufficiently, and then a stress fracture may develop into a completed fracture through the bone.
References
- Harris WH, Heaney RP. Skeletal renewal and metabolic bone disease. N Engl J Med 1969;280:193.
- Lutwak L, Whedon GD. Osteoporosis. DM April 1963, page i.
Source: https://rad.washington.edu/about-us/academic-sections/musculoskeletal-radiology/teaching-materials/online-musculoskeletal-radiology-book/fractures-without-significant-trauma/
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