What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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Findings There is a flattening of the head of the second metatarsal (MT) with a band of low signal about the subchondral bone representing sclerosis and small areas of subchondral cystic change. Collapse of the MT head has yielded a loss of sphericity along the dorsal and plantar margins of the 2nd MT head. There is extensive full thickness cartilage loss and an additional suggestion of ongoing collapse. All of these findings help yield a marked amount of edema of the second metatarsal and a marked degree of synovitis at the second metatarsophalangeal joint (MTP).
What’s the Diagnosis – Case 104
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What’s the Diagnosis – Case 104
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Diagnosis: Freiberg Infraction Freiberg Infraction is a well known but poorly understood process most commonly affecting adolescent to teenage women. It most frequently involves the second MT head with the third being much less commonly involved. The etiology is thought to be multifactorial, perhaps related to chronic trauma, vascular insult, underlying abnormal alignment, and genetic predisposition. It is frequently characterized in the nebulous realm of osteochondrosis. Early on in the process there may be a subtle subchondral fracture that goes on to collapse of the dorsal and then plantar aspect of the metatarsal head. This collapse of the bone precipitates the marked edema of the bone. As the process progresses there is then extensive cartilage loss and arthritis yielding the marked degree of synovitis shown in this case. Early on in the disease process, conservative management may be tried but operative management is necessitated at the later stages of the disease.
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References Talusan PG, Diaz-Collado PJ, Reach JS, Freiberg's infraction: diagnosis and treatment. Jr.Foot Ankle Spec. 2014 Feb;7(1).Review. Schade VL. Surgical Management of Freiberg's Infraction: A Systematic Review. Foot Ankle Spec. 2015 Dec;8(6):498-519. Review. S Ujash. Freiberg's Disease. Orthobullets.
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