diagnosis: frieberg’s infraction (or disease)
x-ray findings (right foot):
1. flattened third metatarsal head with subchondral dense sclerosis and tiny lucencies
2. mild narrowing of the third metatarso-phalangeal joint is noted. hypertrophic spur on the adjacent margin of head of metatarsal is detected, compatible with secondary degenerative change
3. follow-up films yearly (for past 3 years) show no interval change
differentials: tb, gout and ra.
1. laboratory investigations showed that ra factor & uric acid are negative.
2. x-ray shows no para-articular or peri-articular joint erosion.
3. tb dactylitis (involvement of short tubular bone of hand or foot) shows extensive soft tissue swelling, cyst-like cavity formation & ballooning and periostitis.
discussion:
1. trauma to head of metatarsal leading to osteonecrosis, usually 2nd or 3rd mt
2. most common in females, usually second decade
3. history of mild trauma (50%) but this is frequently lacking in the untreated cases
4. a separated dense fragment may be seen, indicating a former episode of osteochondritis dissecans
5. can lead to premature degenerative change and loose bodies |
发表于 2004-7-15 01:45
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发表于 2004-7-16 15:08
发表于 2004-7-18 00:04