Isolated fracture of the medial cuneiform

We report a case of a 21-year-old man who sustained an isolated fracture of the medial cuneiform in a motorcycle accident. To our knowledge, this is the first report of such an injury. We describe his treatment, which included anatomical fixation of the fracture.     

Medical cuneiform fracture-dislocation associated with medial and intermediate cuneiform fractures

We report the microbiological characteristics of two Rahnella aquatilis strains isolated in the faeces of two patients with acute gastroenteritis, one of whom is an AIDS patient. The biochemical behaviour was studied with different automated identification systems, and the few clinical cases to be found in the literature were reviewed. Of the nine strains isolated in clinical samples, two were obtained from blood cultures, two from respiratory samples, one from urine, one from a burn wound, one from a surgical wound, and two (our strains) from faeces. In almost all cases the patient presented an underlying condition facilitating infection by opportunistic microorganisms. The majority of strains are characterized by their resistance to ampicillin, cephalothin and cefoxitin. Due to the rarity of the isolation of R. aquatilis in human samples it is not yet possible to establish, with any degree of certainty, its true pathogenic capacity.     

Stress fracture of the humerus in a weight lifter

Hog cholera virus (HoCV) 5' terminus of the ALD and GPE(-) strains were analyzed by using rapid amplification of cDNA end method (5'RACE). An additional nine nucleotides were found at the 5' termini of genomic RNA in the ALD and GPE(-) strains of HoCV. These nine nucleotides were also conserved in BVDV and were suggested to form a hairpin structure at the 5' terminus by computer-assisted analysis. It seems possible that the secondary structure and/or the 5' terminus sequence has a significant role in the HoCV virus genome.     

Stress fracture of the patella in a palmwine tapper

Stress fracture of the patella in a twenty-nine-year-old palmwine tapper is reported. The fracture occurred during a busy tapping day which was his first working day after a ten-day sick off for a febrile illness and presentation was delayed for six weeks. Initial diagnosis was pathological fracture, but X-ray examination and histology of the biopsy from the fracture site did not suggest any associated disease. The pathomechanics of palmwine tapping is very similar to jumping (parachute) which is the usual cause of this fracture in developed countries.     

Clay-shoveler's fracture. Stress fracture of the lower cervical and upper thoracic spinous processes

Clay-shoveler's fracture is a fatigue fracture of a lower cervical or upper thoracic spinous process. This occupational injury occurs primarily in workers who shovel heavy loads for long periods of time. It was common and well known at the beginning of the XXth century, but has become relatively rare since the introduction of earth-moving machinery, and is now frequently overlooked. A review of clay-shoveler's fracture is presented. Emphasis is put on the legal aspects that can raise problems for rheumatologists, radiologists, occupational physicians and physicians performing expert evaluations of patients filing compensation claims.     

Stress fracture of the sixth rib in an elite athlete

We report on a previously unreported site of rib stress fracture in an elite athlete. A 27 year old sweep rower, a National champion and an Olympic finalist, presented with a 3-day history of the left-side thoracic pain. Technetium 99m bone scintigraphy showed increased focal uptake of the radioisotope, leading to the diagnosis of stress injury of the anterolateral part of the sixth rib. The probable mechanism of this injury was that strong muscle force itself was great enough to produce a fracture. In the case of our rower, the precipitation cause was only a slight change in the rowing technique, in contrast to all other reports on such rib fractures among rowers where the primary cause was an increase in the level of strength training. The treatment included a complete rest of the affected area and upper extremities, while the cardiovascular and strength fitness was maintained. The athlete was able to resume with his standard training routine less than four weeks after the onset of the symptoms.     

Stress fracture of the sternum: an unusual injury?

Stress fracture of the sternum is a rare condition which presents as acute anterior chest pain after repetitive upper-body exercise. Two case reports are presented and it is postulated that this is an often underdiagnosed condition which should be considered in the differential diagnosis of acute chest pain in the athlete. Awareness of the injury together with meticulous clinical examination supported by good quality radiographs or isotope bone scan may lead to an increase in the diagnosis of this injury.     

Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot

We studied twelve patients who had a stress fracture of the tibia and one patient who had a stress fracture of the fibula after arthrodesis of the ankle or the foot. A second stress fracture subsequently developed in two patients. All but two patients were managed non-operatively, and the fractures healed uneventfully. One patient who was managed operatively had a below-the-knee amputation to treat a painful non-union of a tibial fracture, and the other had interlocking intramedullary nailing for a displaced fracture. All but one of the arthrodesis sites had fused before the stress fracture occurred. All of the stress fractures that occurred after arthrodesis of the ankle were in the middle and distal aspects or the distal aspect of the tibia, while those that occurred after triple arthrodesis were in the distal aspect of the fibula or the medial malleolus. Although six of the thirteen patients still had uncorrected alignment and deformity after the arthrodesis, optimum alignment after the arthrodesis did not preclude the occurrence of a stress fracture. We conclude that stress fracture must be considered in the differential diagnosis of pain months or even years after solid fusion at the site of an ankle or triple arthrodesis.     

Metatarsus varus corrected by open wedge osteotomy of the first cuneiform bone

The persistence of metatarsus adductus varus has been a problem in management. We have treated a series of selected patients with this problem and believe that our results have been better than with the procedure we have used in the past. Fowler has described a procedure which seems ideal for the patients in our series. Through personal communication the procedure and its application were discussed and the series was started eight years ago. Our series is small because our patients are responding to other forms of treatment at an earlier age. The few that do not respond are now considered for the operation described. The procedure is relatively simple to perform. Full correction should be obtained at the time of surgery. Casting is utilized to hold the correction and immobilize the extremity for healing. Our unsatisfactory results occurred because of errors in technique or poor selection of patients. We believe that this procedure should be considered in the older patient with metatarsus varus.     

Stress fracture of the fifth metatarsal after Evans' calcaneal osteotomy: a report of two cases

The Evans calcaneal lengthening osteotomy has gained popularity in recent years for the treatment of symptomatic flexible pes planus deformity. To our knowledge, the occurrence of a stress fracture of the fifth metatarsal has not been reported after this procedure. We report two such cases and discuss the probable mechanism of this problem, a relative overloading of the lateral aspect of the foot. Both cases were treated successfully with immobilization. Clinicians should be aware of this possible problem and treat it appropriately.