Devastating Fracture In An Adolescent Runner: Nature Vs. Nurture? - Page #4

Working Diagnosis:
Non-traumatic complete femoral neck fracture with poor healing in an adolescent with the female athlete triad and genetic predisposition for osteoporosis.

Patient and parental education, dietitian referral, sports psychology referral calcium and vitamin D supplementation, bone stimulator and rehabilitation.

In October 2010, she progressed to full weight-bearing and was pain free with a mildly antalgic gait. In therapy she continues to work on motion and is beginning to incorporate strengthening. She has been eumenorrheic since August 2010. It has been recommended that she have an orthopedic surgery second opinion regarding possible surgical revision due to the varus angulation on her recent radiographs.[Photo 5], [Photo 6]

Author's Comments:
The metabolic consequences of a negative energy balance is the same whether or not there is a frank eating disorder present or if it is an inadvertent negative energy balance. This athlete met all the criteria for the female athlete triad: 1. Osteoporosis given her low BMD per revised ACSM criteria and the nature of her fracture 2. Secondary amenorrhea- Functional hypothalamic amenorrhea 3. Negative Energy Balance.

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