Fatigue fracture
Introduction
Introduction to fatigue fracture Fatigue fractures, which are prone to skeletal stress concentration, are one of the common training injuries. The incidence rate is higher in military training, 31% in foreign reports and 16.9% in domestic reports. It is related to super-strength training or improper posture, and it often occurs in frequent long-distance running, off-road training or overload training in a single course. In addition, athletes who are more likely to bear more weight in their feet, such as basketball, football, tennis, track and field, gymnasts and ballet dancers, can also be seen in middle-aged and elderly people who often adhere to high-volume exercise. basic knowledge The proportion of illness: 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: fracture
Cause
Causes of fatigue fracture
Repeated damage caused (90%)
After local long-term repeated minor injury, the trabecular bone fracture occurs first and then repaired. If the external force is continued during the repair process, the repairing disorder and bone resorption can be increased. This process is repeated because the bone resorption is greater than the bone. Repair leads to complete fracture.
Prevention
Fatigue fracture prevention
The development of fatigue fracture is a cumulative damage process from quantitative change to qualitative change. Avoiding bone fatigue damage is the key to prevent fatigue fracture. The movement should be gradual, and a scientific training plan should be formulated according to its own situation, and the amount of exercise should be mastered to avoid bone damage caused by overload exercise.
Those who exercise more, consume enough nutrients every day, supplement calories and water consumed by physical exertion, and increase calcium and vitamin D intake. A new study from Clayton University in the United States shows that even short-term calcium supplementation Both vitamin D and vitamin D can significantly reduce the incidence of stress fractures in athletes.
Complication
Fatigue fracture complications Complications
Sometimes the patella dislocation is visible.
Due to the muscle and ligament traction, the broken end is displaced, and the treatment is not well reset, and malformation may occur.
Symptom
Fatigue fracture symptoms Common symptoms Persistent pain, adduction, fracture, joint swelling, joint sprain, emotional fatigue
The clinical features are local pain, increased after the event, improved after rest, no night pain. Local swelling may be mild and tender, and the stress test is positive.
1. Tibial fatigue fracture: This type of fracture often occurs after recruit training or long-distance marching, so it is also known as a marching fracture.
2. Fatigue fractures of the ribs: There are many osteoporosis in the elderly. If the cough is long-term due to chronic bronchitis and the intercostal muscles are repeatedly violently contracted, rib fatigue fractures may occur.
3. () bone fatigue fracture: Track and field athletes and ballerinas are likely to have fatigue fractures in the lower third of the tibia or the upper third of the humerus, which is related to repeated and violent contraction of the calf muscles, and jumps to the ground with the palms. Related to indirect violence.
Examine
Fatigue fracture examination
X-ray film examination: It has a wide range of applications in the diagnosis of fracture surgical diseases, and is one of the most effective means for early detection, early diagnosis and differential diagnosis. With the accumulation of X-ray examination and diagnostic experience, continuous improvement of equipment and the application of new technologies, X-ray examination has become an indispensable tool in the diagnosis of fracture surgical diseases. Fatigue fractures are mostly negative from 2 weeks to 4 months, and can be followed by periosteal hyperplasia, fracture line, callus or new bone formation.
CT scan: Since the CT scanner scans the human body one by one in a full-angle manner, the information it collects is much more comprehensive than the traditional X-ray scan. Fatigue fractures, CT scans can be seen in the increase of bone marrow density and local soft tissue thickening, providing an important basis for early diagnosis.
Diagnosis
Diagnosis and diagnosis of fatigue fracture
Fractures have microscopic fractures of the bones (visible under the microscope). Early X-rays often show no obvious fractures, but the activity is severe. Because there is no obvious history of trauma, the symptoms are not typical, and it is easy to be misdiagnosed clinically. It should be differentiated from periostitis, osteomyelitis and osteoma.
Grade 0 (normal reconstruction): There is a small periosteal new bone formation, no abnormal changes in X-ray films, no clinical symptoms, but a small linear absorption is observed in the bone scan;
Grade 1 (mild stress response): also manifested as reconstruction of cortical bone, patients may have local pain after exercise, no tenderness, negative X-ray film, but bone scan is positive;
Grade 2 (moderate stress response): Cortical bone resorption is slightly stronger than periosteal reaction, pain and tenderness may occur, X-ray film bone shape is complete, blurred signs are visible, bone scan is positive;
Grade 3 (severe stress response): The periosteal reaction and cortical bone absorption range were enlarged, the pain persisted, and the rest also appeared. X-ray films showed thickening of the cortical bone and positive bone scan;
Grade 4 (fatigue fracture): Bone biopsy showed osteonecrosis, trabecular microfracture and granulation tissue formation. Due to pain, weight bearing was almost impossible. X-ray films showed fracture and early osteophyte formation, and bone scan was positive.
Classification of fatigue fractures based on MRI (nuclear magnetic resonance) findings
Level 0: T1, T2 and STIR images are normal;
Grade 1: T2 and STIR images showed moderate periosteal edema;
Grade 2: T2 and STIR can be seen as obvious periosteum and bone marrow edema;
Grade 3: T1 is like bone marrow edema, T2 and STIR images are characterized by severe edema of periosteum and bone marrow;
Level 4: T1 shows bone marrow edema with low-density signal (fracture line), and T2 and STIR have severe bone marrow edema.
