Pars interarticularis stress fracture

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Case
This male U-20 international player presents with an insidious onset of low back pain. He describes developing increasing low back pain over a three month period that was acutely made worse by an overhead kick. It was initially only painful while playing football but at the time of presentation was also painful at rest.

On examination the player had pain with lumbar extension, especially right sided hyperextension. He was also found to have localised midline tenderness over the L4 and L5 spinous processes.

Findings
An initial lumbar x-ray series was found to be normal. There is increased signal intensity within the pars interarticularis at L5 on the right. No oedema is seen on the left and there was no antero or retrolisthesis. The CT images show an incomplete fracture of the right pars interarticularis region. The fracture margins are irregular with some evidence of resorption consistent with an acute injury, with fracture extension into the medial aspect of the right lamina present.

Discussion
This player was succussfully treated with three months of rest from pain provoking activities combined with a progressive core stability programme. 

Flexion and extension cause greatest loads at L5-S1 and these stresses are concentrated at the pars. The pars region acts as a bony fulcrum during spinal extension and is therefore vulnerable to repetitive loading. This type of injury is more common in young men with players generally presenting between the ages of 15-16 with an insidious onset of low back pain. The L5 level is most commonly affected (85-95%) follwed by L4 (5-15%).

In general MRI is used to diagnose the injury. CT imaging provides better detail and can provide prognostic information. Poor prognostic signs include wide, round and sclerotic fracture margins. Bilateral lesions are less likely to heal while those at L4 are less likely to heal (10% healing) than those at L5 (60%).

Most acute injuries (narrow and sharp fracture margins) can be successfully treated with a period of rest. This can often be quite prolonged (more than 3 months). More chronic lesions (with wider and more sclerotic looking margins) can be treated more aggressively as they are unlikely to heal. When symptoms are more refractory, surgical treatment (generally with direct repair) can be contemplated.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Bangoura
30 juin 2018 15:07

La fracture de fatigue ou fracture de stress est une lésion pour charge des tissus osseux La fracture de fatigue chez l enfant se localise dans 80% des cas l5 et 10& el4 Il ne s agit pas réellement d une fracture mais d une maladie de l adaptaionde l os à l effort pouvant tout pratiquant quelque soit son niveau Il s agit d i.e. lésion par extension forcee ou SURENTRAINEMENT FACTEURS FAVORISANTS Les efforts sportifs excessifs qualitativement et quantitativement exposent à l apparition des microlesions pouvant provoquer des microfissures e l apparition progressive d une fracture de fatigue… Lire la suite »