Pathologic fractures occur in bones weakened by disease, such as osteoporosis, tumors, or infections. The pain from pathologic fractures tends to be more severe and persistent compared to other types because the underlying disease continuously affects bone integrity. These fractures often present with minimal trauma or even during normal activities, leading to sudden, sharp pain at the fracture site. The pain is usually constant and exacerbated by weight-bearing or movement. In cases where malignancy is involved, the pain might also be associated with systemic symptoms like weight loss and night sweats.
Stress fractures are tiny cracks in bones caused by repetitive force or overuse, often seen in athletes or military recruits. The pain from stress fractures typically starts as a dull ache that progressively worsens with continued activity. Unlike pathologic fractures, stress fractures might initially be asymptomatic but become painful over time, especially with weight-bearing activities. The pain usually subsides with rest but can return quickly upon resuming activities. Swelling and tenderness are common at the site of the fracture, and the pain tends to be localized (Mayo Clinic, 2021).
Transchondral fractures involve the cartilage and underlying bone, often occurring in joints like the ankle or knee. These fractures result from acute trauma or repetitive stress that causes a shearing force across the cartilage. The pain from transchondral fractures is usually sharp and immediately following the injury. Swelling and joint effusion (fluid accumulation) often accompany the pain, and joint movement can be severely limited due to both pain and mechanical obstruction caused by loose cartilage fragments. Over time, if untreated, these fractures can lead to chronic pain and joint instability due to cartilage damage. Treatment typically involves addressing any underlying joint pathology, such as osteochondritis dissecans, and may require surgical intervention to restore joint function and alleviate pain (Van Bergen et al., 2021).
References
Mayo Clinic. (2021). Stress fractures: Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/stress-fractures/symptoms-causes/syc-20354057
Johansen, A., Mansoubi, M., & Jordan, K. P. (2020). Pathological Fractures. In StatPearls. StatPearls Publishing.
As someone who has been living with Psoriasis since the age of sixteen, I understand the challenges and misconceptions that come with this condition. It’s often mistaken for seborrheic dermatitis, fungal infections, or eczema. However, Psoriasis is a unique chronic inflammatory skin condition, distinct in its characteristics of thick and silvery plaques, often accompanied by redness. This uniqueness is due to an abnormal immune response involving T cells and cytokines, causing the skin cells to multiply too quickly and accumulate on the skin’s surface. The buildup of cells leads to the characteristic thickening and silvery appearance of the plaques, while the redness results from increased blood flow due to inflammation. The rapid turnover and accumulation of cells also lead to the formation of scales, which are typical of Psoriasis.
Psoriatic treatments are designed to effectively reduce inflammation, slow down the fast turnover of skin cells, and alleviate symptoms. These treatments, including corticosteroids, vitamin D analogs, and retinoids, are applied directly to the affected skin to reduce inflammation and scaling. They are available as ointments, creams, oils, and foams. In more progressive cases, systemic treatments may be needed. Oral medications such as methotrexate and cyclosporine or newer biological agents like TNF-alpha and interleukin inhibitors are some of the systemic treatment options. Some common biologicals are Humira and Otezla. Personally, I use Cimzia as it is considered the safest for pregnancy and breastfeeding. These systemic treatments work by targeting specific immune system components to reduce inflammation and alleviate the symptoms of Psoriasis. When considering which medication is most appropriate, history of symptoms, as well as progression of diseases such as psoriatic arthritis, will help dermatology and rheumatology make a joint decision on medication management.
Another approach is phototherapy, which uses ultraviolet light (UVB or PUVA) to slow skin cell turnover and reduce inflammation. Phototherapy is available both in the office and at home. Small portable phototherapy options are available for some patients with smaller, more isolated areas of Psoriasis, such as on the scalp.
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