Bilateral Femoral Supracondylar Stress Fractures in a Cross Country      Runner

Ross, Kate; Fahey, Mark

doi:10.3928/01477447-20080801-28

Cited by 9 publications

(13 citation statements)

References 7 publications

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“…[58][59][60][61][62][63][64] One study was a case report. 65 Unadjusted BMD data were not reported for 1 study. 66 Nine additional studies were excluded from this systematic review and meta-analysis because LS, FN, or WB BMD data were not presented; 5 of these studies measured BMD at the calcaneum, 61,[67][68][69][70] 3 measured it at the radius (mid and distal), [71][72][73] and 1 measured it at the proximal phalanx of the third finger.…”

Section: Search Summarymentioning

confidence: 99%

Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

et al. 2018

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The numbers of vegans and vegetarians have increased in the last decades. However, the impact of these diets on bone health is still under debate. Objective: This systematic review and meta-analysis sought to study the impact of vegetarian and vegan diets on bone mineral density (BMD) and fracture risk. Data Sources: A systematic search was conducted of PubMed, Scopus, and Science Direct, covering the period from the respective start date of each database to November 2017. Data Extraction: Two investigators evaluated 275 studies against the inclusion criteria (original studies in humans, written in English or Spanish and including vegetarian or vegan diets and omnivorous diets as factors with BMD values for the whole body, lumbar spine, or femoral neck and/or the number of fractures as the outcome) and exclusion criteria (articles that did not include imaging or studies that included participants who had suffered a fracture before starting the vegetarian or vegan diet). The quality assessment tool for observational cohort and cross-sectional studies was used to assess the quality of the studies. Results: Twenty studies including 37 134 participants met the inclusion criteria. Compared with omnivores, vegetarians and vegans had lower BMD at the femoral neck and lumbar spine and vegans also had higher fracture rates. Conclusions: Vegetarian and vegan diets should be planned to avoid negative consequences on bone health. Systematic Review Registration: PROSPERO registration no. CRD42017055508.

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Section: Search Summarymentioning

confidence: 99%

Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

et al. 2018

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“…Stress fractures in children occur most often in the tibia (48%) followed by the metatarsals (19%) [7]. Two stress fractures in the femoral diaphysis have been described in skeletally immature patients [7] and one patient, thought to be nutritionally deficient secondary to a vegan diet, is reported with bilateral femoral supracondylar insufficiency fractures after taking up cross country running [6]. In our patient we concluded that the unique nature of his new repetitive sporting activity has resulted in a force specifically in the medial supracondylarsupraphyseal region, ultimately giving rise to the stress fracture seen.…”

Section: Discussionmentioning

confidence: 97%

“…The adult literature describes two cases in fresh military recruits aged 18 and 19 years which required a longer than normal period of immobilization but went on to heal without event [5]. One report describes bilateral femoral stress fractures in a 14-year-old boy thought to have insufficiency fractures from nutritional deficiency secondary to a vegan diet [6]. This anatomical area is of importance because of the diagnostic dilemma, which a stress fracture in this region may present, particularly in relation to malignant and infectious conditions [7].…”

Section: Introductionmentioning

confidence: 95%

Supracondylar stress fracture of the femur in a child

Bachmann

Gaston

Hefti

2011

Journal of Pediatric Orthopaedics B

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We describe the unique case of a supracondylar-supraphyseal femoral stress fracture in a healthy 13-year-old boy. The importance of careful history taking is emphasized particularly in regard to asking about new, repetitive activities. The important differential diagnosis in this anatomical region is neoplastic disease and the use of imaging, particularly MRI scanning will yield useful information but is not definitive. Regular follow-up and repeat imaging must be undertaken where the diagnosis of stress fracture is made so that the diagnosis can be ultimately confirmed with the appearance of a healing fracture. Active management in lower limb stress fractures with immobilization is also emphasized as it is apparent that such fractures often do not follow a benign course. Immobilization will also help ensure compliance to treatment and follow-up, which can sometimes be difficult in this patient population.

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“…Despite the prevalence of vitamin D deficiency and stress fractures, it is evident from reviewing the current literature that our patient's presentation of bilateral supracondylar femoral stress fractures is uncommon. There are only two previous reported similar cases; the first being a female long-distance runner with bilateral femoral shaft stress fractures as a consequence of over-use from inappropriate training, mal-alignment, nutritional deficiencies, and an endocrine disorder [14] and the second being bilateral femoral supracondylar stress fractures in a cross country runner caused by a vegan diet resulting in low protein and calcium levels [15] . Bilateral supracondylar femoral stress fractures in adolescents is a rare presentation.…”

Section: R R Lmentioning

confidence: 99%

Bilateral Supracondylar Femoral Stress Fractures in an Adolescent: A Case Report

Barimani

Davidson

Al-Obaidi

et al. 2015

International Journal of Orthopaedics

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An 18-year-old male of Somalian ethnic background presented to accident and emergency with severe pain and swelling in his right knee. He had been playing football and described jumping and landing awkwardly on his right side. The patient described a mild but constant right knee pain over the last few years which exacerbated with strenuous activity. He also described similar left sided knee symptoms but had been reassured by his GP that the diagnosis was likely to be growing pains. He had no other past medical history and was a recreational footballer. On examination he had right-sided suprapatellar swelling with moderate effusion of the knee, was neurovascularly intact distally in the limb, had soft compartments and no evidence of an open injury.Bilateral radiographs were performed at presentation with Figure 1 A and B demonstrating an oblique supracondylar fracture of the right femur with evidence of sclerotic fracture edges and Figure 1 C showing a left distal femur indicating evidence of an oblique lucency in the supracondylar region associated with circumferential cortical thickening but no acute cortical break evident.Due to the acute right sided fracture, the patient was admitted and underwent a right retrograde femoral intramedullary nailing to stabilise the injury (Figure 2). A diagnosis of bilateral femoral stress fractures was made by exclusion of a pathological fracture. Pathological fracture was ruled out by clinical examination and history, sending specimens for analysis via histopathology and microscopy showing no evidence of infection or neoplasia and via imaging as described above. ABSTRACTBilateral supracondylar stress fractures of the femur in adolescents is a rare presentation. Due to the uncommon and non-specific presentation there is a high risk of misdiagnosis and thus detrimental complications. We report a case of bilateral supracondylar femur stress fractures in an 18 year old male of Somalian ethnic background who presented to our institution with a right oblique supracondylar fracture of the femur with evidence of sclerotic fracture edges. The patient was found to have symmetrical bilateral stress fractures of the femur which were missed in primary care and as a result of this weakening it ultimately lead to a fracture. Although stress fractures are most commonly seen in the osteoporotic population, other factors include: exercise type, anatomical and hormonal variables. Our case report highlights predisposition to stress fractures and the importance of heightened clinical suspicion when faced with adolescents presenting with chronic musculoskeletal pain.

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Bilateral Femoral Supracondylar Stress Fractures in a Cross Country Runner

Cited by 9 publications

References 7 publications

Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

Supracondylar stress fracture of the femur in a child

Bilateral Supracondylar Femoral Stress Fractures in an Adolescent: A Case Report

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