0:01

The history on case two is a 15 year old with right foot pain,

0:05

no known injury. So here just hanging are T ones,

0:10

T twos up top and nice sag. So here,

0:15

uh, on these images, we can see that there's, um,

0:20

some non-specific, uh, mar edema, particularly centered at, uh,

0:24

the navicular. So this is, uh,

0:27

classic for at least a stress, uh, injury or reaction. Okay?

0:32

And, uh, sometimes we don't always see the, uh, fracture line.

0:37

Um, but this, uh, in this case, um, you know,

0:41

I would obviously, uh, try to get more history and, uh, uh,

0:46

particularly listening or looking for, uh, a history of, uh,

0:51

potential, uh, this patient, uh, uh,

0:54

involved in repetitive jumping activities. Um, uh,

0:57

these navicular stress reactions or fractures, uh, uh,

1:02

or injuries are, are typically, uh, seen in, um, uh,

1:06

jumpering jumping athletes, uh, for instance,

1:09

basketball players or volleyball players. And, um,

1:13

it's been shown in the anatomic literature that, uh, there's, uh,

1:18

the navicular bone in the foot has a relative zone

1:23

of central, uh, a vascularity. And what happens is, um,

1:28

these patients will develop stress fractures, typically centrally,

1:33

and these, uh, when they, when they happen there, because it's in that zone of,

1:37

uh, relative area of a vascularity,

1:40

it's sometimes very difficult to heal. Um, um,

1:45

and the other thing too, if, if, um,

1:47

the other thing to think of when you have a history of no known injury and you

1:52

have a non-specific marrow edema and no trauma,

1:55

one thing I also wanna point out, uh, to include or look, think about, uh,

1:59

to look for is, um, an osteo, osteo, uh,

2:03

they can happen as we know in the foot, probably more commonly at the tails,

2:07

right? But, uh, anytime you have marrow edema, particularly in a,

2:12

in a younger patient without a good history of, you know, activity, let's say,

2:16

or maybe a, a recent trauma,

2:18

that's something that you want to think about and maybe recommend a, a, a ct.

2:22

'cause as we all know, CT is, uh, is the favored, um, me,

2:27

uh, modality to look for that, uh, small NIUs of the, uh,

2:32

osteo osteo. But this, uh, just turned out to be a stress injury or fracture,

2:37

uh, presumably in this, uh, young active, uh, patient.