The 42 Year-Old Tennis Player Heard a Crack: What I Do, Tension Side - - PowerPoint PPT Presentation

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The 42 Year-Old Tennis Player Heard a Crack: What I Do, Tension Side - - PowerPoint PPT Presentation

Dec 20, 2022 41 likes •648 views

The 42 Year-Old Tennis Player Heard a Crack: What I Do, Tension Side or Compression Side, and Outcomes Edward A. Perez, M.D. Campbell Clinic/University of Tennessee Memphis, TN A Tale of 4 Hips A Tale of 4 Hips A Tale of 4 Hips A Tale of

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The 42 –Year-Old Tennis Player Heard a Crack: What I Do, Tension Side or Compression Side, and Outcomes

Edward A. Perez, M.D. Campbell Clinic/University of Tennessee Memphis, TN

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A Tale of 4 Hips

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A Tale of 4 Hips

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A Tale of 4 Hips

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A Tale of 4 Hips

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Definition

  • First described in Prussian soldiers by

Breithaupt in 1855

  • “March Fractures”
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Definition

  • Repeated high stress
  • Alteration in the balance of bone

remodeling

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Osteoclastic Osteoblastic

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Osteoblastic Osteoclastic

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Osteoblastic Osteoclastic

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Osteoblastic Osteoclastic

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Porous, weakened cortex Microscopic cracks Decreased bone strength Microfracture propagation (Stress Fx) Frank Fracture

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Porous, weakened cortex Microscopic cracks Decreased bone strength Microfracture propagation (Stress Fx) Frank Fracture

Repeated stress

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Porous, weakened cortex Microscopic cracks Decreased bone strength Microfracture propagation (Stress Fx) Frank Fracture

Repeated stress Repeated stress

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Stress Fractures

  • Repeated high stress
  • Normal bone
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Stress Fractures

  • Repeated high stress
  • Normal bone

Insufficiency Fractures

  • Normal or physiologic

stress

  • Weakened bone
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Stress Fractures

  • Repeated high stress
  • Normal bone

Insufficiency Fractures

  • Normal or physiologic

stress

  • Weakened bone
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Who Gets These?

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  • Military recruits
  • Women > Men
  • Runners (69% of stress fxs)

» 2-8% male » 13-37% female

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  • Military recruits
  • Women > Men
  • Runners (69% of stress fxs)

» 2-8% male » 13-37% female

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Classification (Fullerton and Snowdy 1988)

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Classification (Fullerton and Snowdy 1988)

Tension

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Classification (Fullerton and Snowdy 1988)

Compression

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Classification (Fullerton and Snowdy 1988)

Displaced

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Classification (Arendt and Griffiths 1997)

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Classification (Arendt and Griffiths 1997)

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Classification (Arendt and Griffiths 1997)

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Presenting Symptoms

  • Anterior groin pain

– Gluteal – Thigh

  • Increase in activity
  • Easy to miss
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Treatment

  • Compression

<50% Conservative >50% Surgical

  • screws
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Treatment

  • Tension

– Fx at risk – Surgical

  • Screws
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Treatment

  • Displaced

– Surgical – Screws vs. CHS

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#1

  • 51 yo female
  • Training for St. Jude Marathon
  • Gradual onset anterior hip pain
  • No hormonal abnormalities
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MRI

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#2

  • 29 yo female
  • Competetive runner (50k)
  • Anterior groin pain, lateral thigh pain
  • Nl Menstruation
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last 11/20/17

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#3

  • 43 yo female
  • Pain in lateral thigh, sudden onset 5 wks ago
  • Seen at minor med - medrol dose pack
  • Seen at Ortho MD - troch injection, xr nl
  • Increase in while in China
  • Returns to US 5 days later
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1 yr

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#4

  • 36 yo male
  • Sudden hip pain after a run (6wks prior)
  • Rest - better - rode bike - pain – rest - home

improvement project - really bad pain - walk-in clinic

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Complications

  • Tension sided and Compression sided fx’s

(>50%) treated non-operatively

  • Varus malunion
  • Displacement

– 30-60% complication rate

  • AVN 42%
  • Delayed union 9%
  • Nonunion 9%
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Summary

  • High repetitive stress
  • Abnormal remodeling cascade
  • Anterior hip pain
  • High index of suspicion
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Summary

  • Compression <50% observe
  • Compression >50%
  • Tension
  • Displaced

Surgical Stabilization

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Thank You

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Classification (Fullerton and Snowdy 1988)

Tension Compression Displaced

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Female Athlete Triad

Stress Fractures

  • Repeated high stress
  • Normal bone

Insufficiency Fractures

  • Normal or physiologic

stress

  • Weakened bone