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

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 4 Hips

Definition • First described in Prussian soldiers by Breithaupt in 1855 • “March Fractures”

Definition • Repeated high stress • Alteration in the balance of bone remodeling

Osteoclastic Osteoblastic

Osteoclastic Osteoblastic

Osteoclastic Osteoblastic

Osteoclastic Osteoblastic

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

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

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

Stress Fractures • Repeated high stress • Normal bone

Insufficiency Fractures Stress Fractures • Repeated high stress • Normal or physiologic stress • Weakened bone • Normal bone

Insufficiency Fractures Stress Fractures • Repeated high stress • Normal or physiologic stress • Weakened bone • Normal bone

Who Gets These?

• Military recruits • Women > Men • Runners (69% of stress fxs) » 2-8% male » 13-37% female

• Military recruits • Women > Men • Runners (69% of stress fxs) » 2-8% male » 13-37% female

Classification ( Fullerton and Snowdy 1988 )

Classification ( Fullerton and Snowdy 1988 ) Tension

Classification ( Fullerton and Snowdy 1988 ) Compression

Classification ( Fullerton and Snowdy 1988 ) Displaced

Classification ( Arendt and Griffiths 1997 )

Classification ( Arendt and Griffiths 1997 )

Classification ( Arendt and Griffiths 1997 )

Presenting Symptoms • Anterior groin pain – Gluteal – Thigh • Increase in activity • Easy to miss

Treatment • Compression <50% Conservative >50% Surgical -screws

Treatment • Tension – Fx at risk – Surgical • Screws

Treatment • Displaced – Surgical – Screws vs. CHS

#1 • 51 yo female • Training for St. Jude Marathon • Gradual onset anterior hip pain • No hormonal abnormalities

MRI

#2 • 29 yo female • Competetive runner (50k) • Anterior groin pain, lateral thigh pain • Nl Menstruation

last 11/20/17

#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

1 yr

#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

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%

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

Summary • Compression <50% observe • Compression >50% Surgical • Tension Stabilization • Displaced

Thank You

Classification ( Fullerton and Snowdy 1988 ) Tension Compression Displaced

Female Athlete Triad Insufficiency Fractures Stress Fractures • Repeated high stress • Normal or physiologic stress • Weakened bone • Normal bone