Treatment of stress fracture

Stress fracture and Shakespeare

“TIME OUT OF JOINT.”

There is a good study done by the Israeli army.

Interpretation and Classification of Bone Scintigraphic Findings in Stress Fractures. S. Tzila Zwas, Raya Elkanovitch, and George Frank.  J Nucl Med 28:452-457, 1987

Stress or fatigue fractures are often not true fractures, since there is no loss of structural continuity. They begin at sites of accelerated normal remodeling of cortical bone. A true fracture occurs only when the removal of cortex is accelerated beyond the capacity of the periosteal reaction to offer adequate reinforcement. Thus, it seems that the term stress or fatigue "fracture" limits the meaning of the full range of stress bone injuries appearing in the evolution of the dynamic osteogenic bone response. Because of the reactive nature of the lesion and the continuous nature of the bone response to stress in this process, its scintigraphic, as well as radiographie, appearance varies with the time of discovery.

First of all is not a fracture, it is a finding by technology that corresponds or not to pain on specific part of the body.

There was often a discrepancy between persistent or recurrent pain and finding of the stress fracture lesions on scintigraphy. A completely resolved lesion was occasionally accompanied by persistent pain and, as previously mentioned, scintigraphic stress fracture findings were sometimes asymptomatic (painless).

Doctors always claimed, “Time out of joint.” I am a doctor but became the devil’s advocate because I am precisely that, “I help people not to lie to themselves to have a better answer for their problems; and for that same reason, to have a chance of having a better life.”  The lesion is there and one does not have pain; the lesion is not there but the pain persists.  It looks like we are “curing” instrument instead of taking a look at patients and illnesses.  Close to 90% of the low-back-pain operated do not improve with surgery.  Pain is a symptom that needs a Batesonian approach.

Bateson, the one mentioned in the previous post of this blog who spoke about education “rip off,” makes his point because of the way people approach causality.  Pain=lesion do not correspond.  Actually, I know only a sign and a symbol that correspond one-to-one; that is smoke and fire.

In 1800’s, in France, the investigation of why people was getting ill with tuberculosis started.  We did not know anything about microorganism, so causality was approach differently.  They found out that people, who were living in overcrowded rooms, the poor (poorly fed) in the city, were the majority of the people with tuberculosis.  The remedy was to send them outside the city to breath fresh air.  We still have the same problem but the one to blame is the bacillus; education-politics plays a major role in our perception of reality.  PLEASE SEE THE PARALLEL WITH STRESS FRACTURE.  Poor and out of time frame nutrition, lack of recovery, poor technique produce the findings on X rays or scintigraphy.  The remedy we know what it is: BETTER EDUCATION.  Unless we stop avoiding the real issue we cannot have an answer to this problem.