Femoral Neck Stress Fracture

[KnottedYet]

As long as you're getting a density scan and such, you might also want a blood antibody test run to see if you have celiac disease. It can show up as bizarre symptoms, and often ties in with unusual bone issues.

[ruffianxc]

The patient I saw with this actually was about 20 years old and had an eating disorder. I saw another girl with an eating disorder who had several stress fractures and would not stop running.

Compression type is the good type if your avoiding surgery from what I remember. No guarantee no surgery but sounds better than what I originally thought.

However it won't heal as well if you don't have good nutrition.

Unless you get a couple stress fractures I don't think they need to test you for any endocrine or immune causes as there are lot with bone problems and it is most likely just a stress fracture caused by stress and diet from what you said. Those tests can get expensive and I don't think there would be enough concern of some underlying disease as you didn't mention other fractures.

I'm a 4th year med student and I shadowed in a sports medicine clinic for 2 years. I don't know a lot but I did see this.

[KnottedYet]

[QUOTE=ruffianxc;470987]

However it won't heal as well if you don't have good nutrition.

QUOTE]

Celiac disease is a disease whose myriad symptoms are a consequence of inadequate nutrition, aided and abetted by the autoimmune issues. One of the more exciting symptoms is osteopenia/osteoporosis at an unusually young age. If someone has been restricting the diet AND has a nutrient absorption issue (like celiac disease) they could experience heightened bone fragility beyond what would be expected with just one issue.

The screen is a simple blood draw, while the patient is still eating their average diet.

[KnottedYet]

I'm a 4th year med student and I shadowed in a sports medicine clinic for 2 years. I don't know a lot but I did see this.

It's amazing; the longer I practice, the less I know.

One valuable thing I've learned over the years: a patient will present with one problem, but most of the time that one problem has more than one cause. Patients with only one issue don't come in, their body copes so they don't seek medical help. When the body starts juggling multiple issues, it begins to drop things, and that's when problems show up.

I cringe when I think of the patients I misled and the issues I missed. And in all honesty, I'm probably still misleading and missing. That's why it's called "practice."

[ruffianxc]

Yeah I understand you could get celiac screening, I've just never seen people get screening tests for a stress fracture. I would imagine if you noticed nonunion or repetitive fracturing it would be a good idea. All of my experience with stress fractures are pediatric/ college age kids who are generally healthy can have no other complaints so we never really have high suspicion of these things. I guess I'd think you'd be getting a lot of blood work and in addition to the cost of the test if you tested all stress fractures you'd have to deal with the cost of false positives or further work up. Additionally if you got celiac would you have to get all the other possible things that could be causing osteopenia.

I am doing metabolic bone research this year, taking the entire year off in the lab, and after reading so much about bone disease I just would wonder if you did decide to look into celiac disease, as you thought you had high enough suspicion of it, wouldn't you be obligated to look into at least some other common ones. That would be a lot to do on every stress fracture.

Interesting though.


Yeah practice is interesting. I guess you can only do the best you can do with what you got: the knowledge and judgement you had at that moment.

I agree with what your saying about complex problems and sometimes people come in saying they are worried about x and really they are worried about something else entirely but they didn't want to say it.

As of now I want to go into sports medicine so these questions I find interesting.