0:01

<v ->And then finally, Freiberg's infraction.

0:05

You know, there's always been an argument, what causes this?

0:08

I hope you all remember

0:10

that this is a disorder involving metatarsal heads,

0:14

the most common location.

0:16

The second, described by Freiberg in 1914

0:22

sometimes multiple metatarsal heads were involved,

0:25

unilateral or bilateral distribution.

0:28

The rarest location was the first metatarsal head.

0:33

The exact cause of this was not known.

0:35

In fact, it was listed as one of the osteochondrosis,

0:40

like Legg-Perthes disease and Osgood-Schlatter disease.

0:45

We didn't know exactly what caused it.

0:48

What we saw radiographically was flattening

0:51

and fragmentation of the metatarsal head.

0:54

Later on, intra-articular bodies might be located.

0:58

Well, there are multiple causes of Freiberg's infraction.

1:02

In an active trial, shown here,

1:05

it appears to be a stress fracture.

1:08

And if there is osteonecrosis,

1:10

it would be a secondary event.

1:13

In an elderly woman with osteoporosis,

1:16

it may represent an insufficiency fracture

1:20

involving the subchondral bone.

1:23

And it's a finding that we see in diabetics

1:26

perhaps related to a neuropathic fracture

1:30

with subsequent disorganization of the joint.

1:34

So again, linking together things

1:37

that look like osteonecrosis with fatigue fractures,

1:41

insufficiency fractures, and neuropathic fractures.

1:46

I'm gonna stop there for the moment.

1:48

We're gonna go on our second case discussion by Abdalla.