Musculo-skeletal   [back to the Category]

General comments on osseous trauma and microtrauma   [read the french version]

Author :   Docteur Anne Thiescé

Fracture = sudden, complete solution of bone continuity. Fig.1

The fractured osseous segment, together with the upper and underlying articulations must be completely immobilised. Consolidation takes between 6 and 8 weeks, maximum solidity comes after 10 weeks. There is a risk of complication if these immobilisation time periods are not respected; leading to pseudarthrosis with non-consolidation after 6 months and, therefore constant pain, or the vicious callus caused by secondary displacement of osseous parts with hypertrophy of the callus causing occasional pain.

Stress fracture = partial progressive occurrence of solution of continuity. Fig.2
These fractures are linked to osteo-formation exhaustion and an increase in osteo-destruction or osteolysis due to osseous hyper-solicitation.
Pain is localised, sometimes moderate or beginning suddenly. Palpation and osseous percussion reveal an exquisite pain over a limited area which is sometimes tumified. X-rays are negative in the early stages, the diagnosis is made by scintigraphy. It shows a focal hyperfixation which will be multi-focal in the case of multiple fractures.
Rest is imperative, activities can be resumed when the pain has gone completely and / or when a check-up shows a negative scintigram. Resuming activities too soon will result in the same injurious consequences as for complete fractures.

Periostitis = microtraumatic lesions of the musculo-tendinous attachments with the periosteum.

The periosteum is a connective membrane surrounding the bone. The principal bone in question is the tibia. Periostitis is caused either by a direct trauma or by microtrauma resulting from the muscular insertion aponevroses pulling during exertion. It is, in fact, a muscular insertion illness that demonstrates excessive osseous pulling and that, perhaps, forms a transition with stress fractures.

Epiphyseitis, apophysitis = growth illnesses found in children, in particular, apophyseal avulsions.

Apophyseal centres are the start of ossification zones which cause osteogenesis. They usually correspond to tendinous insertions (where the tendons are attached to the bone) and are, therefore, submitted to a great amount of pulling and microtrauma.
Ballet dancers can suffer from two kinds of lesions:
-chronic apophysitis: this is capitular epiphyses osteochondrosis. A lesion whose symptoms resemble those of adult insertion tendinitis, due totally to apophysis overexertion.
- Apophyseal avulsion with fracture either of the centre itself or of the ossification zone: these avulsions occur suddenly during abrupt stretching of a muscle that is not completely relaxed. It is due to a lack of synchronization between the abrupt contraction of the agonist muscles and the essential relaxation of the stretched antagonist muscles. Resulting in complete or partial avulsion of an apophyseal centre that succumbs to the abrupt stretching of the muscle with a corresponding insertion point. Fig.3. This can sometimes give rise to the formation of osteoma which can become a nuisance either because of their size or because of their location.