Lower-extremity stress fractures account for an estimated 16% of all injuries among runners. The April 2016 “Case Connections” article sprints forward from an April 13, 2016, Case Connector report about a stubborn running-related stress fracture of the inferior pubic ramus that did not respond to the usually successful conservative approach.
It’s often challenging for orthopaedists to make a diagnosis in a patient group in whom multiple musculoskeletal injuries or ailments may exist. Patients with suspected stress fractures may have radiographs with subtle, easily overlooked findings. A bone scan and/or other advanced imaging are often required to make a definitive fracture diagnosis.
Continued running due to a missed diagnosis or a patient’s ardent noncompliance can culminate in complications that may eventually require surgical intervention. The best outcomes are perhaps achieved in a setting that fosters strong collaboration between the surgeon, patient, physiatrist, and/or physical therapist with expertise in the mechanisms and physiology of running.
In a postscript to this Case Connections article, JBJS Case Connector co-editor Tom Bauer, MD describes his fateful experience with a calcaneal stress fracture while running the 2013 Boston Marathon.
The 2013 Boston Marathon was stolen from the athletes and the city by two terrorist bombs, which led to four deaths, hundreds of injuries, a city shuttered for long stretches, and a tense manhunt that concluded with one suspect dead and the other injured. But the 2013 Marathon wasn’t finished until the end of the day on April 21, 2014. Marathon Monday 2014 in Boston was a glorious day for more than 32,000 runners and more than a million spectators. It was a day throughout which the outcomes of orthopaedic, disaster preparedness, physical therapy, and emergency medicine teamwork were again on display.
From prosthetic limbs to fundraising groups paying it forward, the 2014 Boston Marathon was inspiring end-to-end. As thousands of runners observed a moment of silence in the chill morning at the Hopkinton start, the profound shared experience of the past year or years settled upon them. Urged to “Take back that finish line!” the runners ran through sun-filled streets to the finish line 26.2 miles away. Children, families, and strangers clapped, shouted, and urged them on every step of the way.
In March, in conjunction with our friends at the Journal of Orthopaedic and Sports Physical Therapy (JOSPT), we published a special report on the emergency preparedness, long-term care, and outcomes for many of those caught up in last year’s Marathon bombings. This report is available online for free at http://sites.jbjs.org/ittakesateam/2014/. I urge you to take a look.
If there was ever an event that showed how the skill, knowledge, and diligence of medical professionals benefited people with the resolve and strength to make the most of it, the 2014 Boston Marathon was that event. As families embraced at the finish line, as friends, heroes, and survivors shared in the accomplishment of completing not just one marathon but so much more, one theme stood out: the amazing strides made possible through teamwork in orthopaedic care, physical therapy, emergency medicine, trauma surgery, and system-wide planning.
On April 15, 2013, on a sunny day in Boston, thousands gathered to watch the oldest marathon in the US. They were cheering family, friends and colleagues who were accomplishing a feat they had trained for all year. No one expected the next wave of events – two bombs exploded near the finish line of the race, killing three people and injuring more than 260. The pictures and images looked like a warzone. What followed next was also unprecedented. Orthopaedists, first responders, trauma surgeons, other medical professionals, runners, and spectators jumped in to help the bomb victims, many using tourniquets to stop the bleeding.
Many of the surgeons treating these victims had previous military training, helping 14 people who ended up with amputations and a dozen other victims whose limbs so far have been spared. According to Dr. James Ficke, chairman of the department of orthopedics and rehabilitation at San Antonio Military Medical Center, “a multidisciplinary approach that involves everyone from plastic and orthopedic surgeons to therapists is important.”
According to NBC News reporters, Bill Dedman and John Schoen, from a financial perspective, the Boston Marathon bombing will cost as much as $333 million in losses to the local economy and infrastructure damage. The total cost of care for 70 hospitalized patients could exceed $9 million, according to one calculation. Read more.