Insufficiency and stress fractures of the long bones occuring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography

Lingg, G.; Soltèsz, Inga; Kessler, S; Dreher, Raı́ner

doi:10.1016/s0720-048x(97)00039-9

Cited by 22 publications

(11 citation statements)

References 15 publications

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“…Insufficiency stress fractures are mal-adaptations of poor quality bone in the form of deficient elastic resistance in response to normal muscle strain, and these can result in significant levels of morbidity [1,2]. The 2nd metatarsal is one of the most common sites of insufficiency fracture in people with poor bone strength, whereas fatigue-type stress fractures in athletes and military recruits which are characterized by abnormal stresses being applied to bone which has normal elastic resistance due to muscle fatigue [2-6].…”

Section: Introductionmentioning

confidence: 99%

“…The 2nd metatarsal is one of the most common sites of insufficiency fracture in people with poor bone strength, whereas fatigue-type stress fractures in athletes and military recruits which are characterized by abnormal stresses being applied to bone which has normal elastic resistance due to muscle fatigue [2-6]. The reasons for the predilection of fractures at the 2 nd metatarsal remain unclear; however the research evidence suggests that the 2 nd metatarsal may be prone to greater levels of bone strain relative to the lesser metatarsals [3,7].…”

Section: Introductionmentioning

confidence: 99%

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Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Chaplais

Greene

Hood

et al. 2014

BMC Musculoskelet Disord

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BackgroundPeripheral quantitative computed tomography (pQCT) is an established technology that allows for the measurement of the material properties of bone. Alterations to bone architecture are associated with an increased risk of fracture. Further pQCT research is necessary to identify regions of interest that are prone to fracture risk in people with chronic diseases. The second metatarsal is a common site for the development of insufficiency fractures, and as such the aim of this study was to assess the reproducibility of a novel scanning protocol of the second metatarsal using pQCT.MethodsEleven embalmed cadaveric leg specimens were scanned six times; three times with and without repositioning. Each foot was positioned on a custom-designed acrylic foot plate to permit unimpeded scans of the region of interest. Sixty-six scans were obtained at 15% (distal) and 50% (mid shaft) of the second metatarsal. Voxel size and scan speed were reduced to 0.40 mm and 25 mm.sec-1. The reference line was positioned at the most distal portion of the 2nd metatarsal. Repeated measurements of six key variables related to bone properties were subject to reproducibility testing. Data were log transformed and reproducibility of scans were assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV%).ResultsReproducibility of the measurements without repositioning were estimated as: trabecular area (ICC 0.95; CV% 2.4), trabecular density (ICC 0.98; CV% 3.0), Strength Strain Index (SSI) - distal (ICC 0.99; CV% 5.6), cortical area (ICC 1.0; CV% 1.5), cortical density (ICC 0.99; CV% 0.1), SSI – mid shaft (ICC 1.0; CV% 2.4). Reproducibility of the measurements after repositioning were estimated as: trabecular area (ICC 0.96; CV% 2.4), trabecular density (ICC 0.98; CV% 2.8), SSI - distal (ICC 1.0; CV% 3.5), cortical area (ICC 0.99; CV%2.4), cortical density (ICC 0.98; CV% 0.8), SSI – mid shaft (ICC 0.99; CV% 3.2).ConclusionsThe scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2nd metatarsal. This protocol extends the capabilities of pQCT to evaluate bone quality in people who may be at an increased risk of metatarsal insufficiency fractures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Chaplais

Greene

Hood

et al. 2014

BMC Musculoskelet Disord

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“…The associated pain and disability are often attributed to rheumatoid joint involvement. They are difficult to detect clinically and may not be visible on radiographs obtained near the onset of symptoms; therefore, serial examinations may be needed for diagnosis10 – 12 and a bone scan should be performed for early diagnosis 13…”

Section: Discussionmentioning

confidence: 99%

An unusual cause of apareunia

Karim

Clayson²,

Jones³

2009

Case Reports

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A 49-year-old woman with history of rheumatoid arthritis presented with worsening pelvic pain. A pelvic computed tomography (CT) scan demonstrated a fracture and a lytic expansile lesion within the right superior and inferior pubic rami. The diagnosis of "insufficiency fractures secondary to rheumatoid arthritis" was established. Six months later, she started describing pain and fullness sensation in the vagina which eventually led to a complete apareunia. An x ray confirmed healing of the previous fractures, fracture of both left superior and inferior pubic rami, and an upwards shift of the right hemi-pelvis. Conservative management was chosen. Twelve months later, no improvement occurred and she was still apareunic. A "corrective osteotomy surgery" was performed and the displaced pubic rami and ischial tuberosities were remodelled bilaterally through a vertical incision over each labia majora. These bones were partially excised until an adequate vaginal opening was established. Her symptoms have impressively resolved with complete reverse of the apareunia.

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“…Das gleiche gilt für den Verlauf von Frakturen nach Beginn der medikamentösen, diätetischen und physikalischen Therapie. Die Röntgendiagnostik wird darüber hinaus -bei zunehmender Kenntnis von Komplikationen der Osteoporose, den so genannten Insuffizienzfrakturen -zu deren Aufdeckung und Verlaufskontrolle [7,8] verwendet, sowie weiterhin zur Diagnose von Therapiefolgen wie der Fluorose eingesetzt [8].…”

Section: Diskussion Und Klinische Wertung Der Methodenunclassified

Methoden der Bildgebung und der Knochendichtemessung bei der Osteoporose im Rahmen entzündlich-rheumatischer Erkrankungen

Lingg¹

2006

Z. Rheumatol.

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Besides clinical history and clinical findings conventional X-ray is important in the evaluation of osteoporosis as the third diagnostic tool. Its purpose is mainly excluding other diseases and proof of fractures as well as their follow up. Also X-ray is able to demonstrate complications of osteoporosis such as insuffiency fractures and effects of therapy as for example fluorosis. For very early diagnosis bone densitometry is used. Today the improved methods deliver fracture prediction percentages of high value. As a planar measurement method DXA of the spine and of the femoral neck can be used. Volumetric tools, which can measure trabecular bone, without overlying cortical bone, are computed tomography of the spine and of the distal radius. Quantitative ultrasound is an interesting approach, but which does not really measure bone densitometry and which is net yet suited for clinical follow up. Quantitative Magnetic Resonance is far from routine clinical application.

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Insufficiency and stress fractures of the long bones occuring in patients with rheumatoid arthritis and other inflammatory diseases, with a contribution on the possibilities of computed tomography

Cited by 22 publications

References 15 publications

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

An unusual cause of apareunia

Methoden der Bildgebung und der Knochendichtemessung bei der Osteoporose im Rahmen entzündlich-rheumatischer Erkrankungen

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