Q. a nurse presented with dull, vague, recurrent pain in the forefoot region that used to be increased after duties and relieved at rest. The complaint is for the last eight weeks. The radiographs are given below and select best answer to explain her problem?
1. benign tumor of metatarsal
2. Myositis ossificans
3. Bizarre Parosteal Osteochondromatous Proliferation (BPOP)
4. Stress fracture
Answer.
Stress fracture. as per the consideration of her occupation requiring constant use of foot and also the site known for stress injuries i.e. March fracture. The regular stress causes fracture that may not be noticed or considered not significant that is why most of these are diagnosed late with callus formation as in this case.
The close contender is BPOP also called Nora's lesion. these are osteoproliferative condition with characteristic radiographic and histologic features. Confirmation by histopathology and more commonly involve hand (metacarpals, phalanges)
Benign tumor like enchondroma may be ruled out as these are intramedullary , expanding lesions and generally not cause PAIN till pathological fracture ensues. The radiological feature is also not that of enchondroma,.Other tumor like malignant ones are not considered here due to nonspecific history and presentation.
Myositis ossificans often follow a significant trauma to bone and soft tissue , often with history of massage which is not present here.
Footnote- better answer here should be 'insufficiency fracture' . there is subtle difference between stress and insufficiency fractures. Stress fracture result from extraordinary stress over normal bone while insufficiency fracture results from normal stresses over bone with poor healing capacity.
1. benign tumor of metatarsal
2. Myositis ossificans
3. Bizarre Parosteal Osteochondromatous Proliferation (BPOP)
4. Stress fracture
Answer.
Stress fracture. as per the consideration of her occupation requiring constant use of foot and also the site known for stress injuries i.e. March fracture. The regular stress causes fracture that may not be noticed or considered not significant that is why most of these are diagnosed late with callus formation as in this case.
The close contender is BPOP also called Nora's lesion. these are osteoproliferative condition with characteristic radiographic and histologic features. Confirmation by histopathology and more commonly involve hand (metacarpals, phalanges)
Benign tumor like enchondroma may be ruled out as these are intramedullary , expanding lesions and generally not cause PAIN till pathological fracture ensues. The radiological feature is also not that of enchondroma,.Other tumor like malignant ones are not considered here due to nonspecific history and presentation.
Myositis ossificans often follow a significant trauma to bone and soft tissue , often with history of massage which is not present here.
Footnote- better answer here should be 'insufficiency fracture' . there is subtle difference between stress and insufficiency fractures. Stress fracture result from extraordinary stress over normal bone while insufficiency fracture results from normal stresses over bone with poor healing capacity.
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ReplyDeleteThanks for the precise opinion sir,
It is valued especially when it comes from a leading authority like you.
Have great time.