tailieunhanh - Gãy xương có nguy cơ cao: Đánh giá và điều trị

Gãy xương căng thẳng đang bị thương sử dụng quá mức thường thấy ở các vận động viên và tuyển quân sự. Sinh bệnh là đa yếu tố và thường liên quan đến căng thẳng lặp đi lặp lại submaximal. | High-Risk Stress Fractures Evaluation and Treatment Barry P. Boden MD and Daryl C. Osbahr Abstract Stress fractures are common overuse injuries seen in athletes and military recruits. The pathogenesis is multifactorial and usually involves repetitive sub-maximal stresses. Intrinsic factors such as hormonal imbalances may also contribute to the onset of stress fractures especially in women. The classic presentation is a patient who experiences the insidious onset of pain after an abrupt increase in the duration or intensity of exercise. The diagnosis is primarily clinical but imaging modalities such as plain radiography scintigraphy computed tomography and magnetic resonance imaging may provide confirmation. Most stress fractures are uncomplicated and can be managed by rest and restriction from the precipitating activity. A subset of stress fractures can present a high risk for progression to complete fracture delayed union or nonunion. Specific sites for this type of stress fracture are the femoral neck tension side the patella the anterior cortex of the tibia the medial malleolus the talus the tarsal navicular the fifth metatarsal and the great toe sesamoids. Tensile forces and the relative avascularity at the site of a stress-induced fracture often lead to poor healing. Therefore high-risk stress fractures require aggressive treatment. J Am Acad Orthop Surg 2000 8 344-353 Stress fractures are common injuries frequently seen in athletes and military recruits. Although the reported incidence of stress fractures in the general athletic population is less than 1 the incidence in runners may be as high as 20 . In a review of 370 athletes with stress fractures the tibia was the most commonly involved bone of cases followed by the tarsals and the metatarsals .1 Bilateral stress fractures occurred in of cases. With the increasing emphasis on exercise for the elderly stress fractures should not be overlooked in this population. Although stress fractures