Stress fractures of the tarsal navicular. A case report.

In summary, the diagnosis of a tarsal navicular stress fracture should be entertained in the athlete with ill-defined midfoot pain. Technetium bone scans will often point the clinician in the right direction; biplanar CT scans will pin-point the diagnosis and can be invaluable in perioperative planning. Subsequent treatment, however, must be determined on a clinical rather than a radiographic basis.

Viability of intramedullary canal bone reamings for continued calcification.

The viability of intramedullary canal bone reamings as a potential bone graft material was examined. Intramedullary bone reamings were obtained from the tibia or femur of three patients during intramedullary nailing procedures. Histologic examination showed bone marrow elements with complete disruption of the marrow compartmental organization. Bone trabeculas were present in a randomly scattered fashion with no structural organization. To assess the viability after reaming of the material for continued calcification, implants of the reaming material were placed in a pocket made in the gluteus maximus muscle of 12 rats. After 7 days, the implanted bone spicules showed evidence of tetracycline label uptake, indicating the material obtained after reaming the intramedullary canal was still viable and capable of continued calcification. That the intramedullary canal bone reamings may be a source of bone graft material is interesting. The reamings appear to continue an osteoproductive capacity when used as a graft.

Occult foreign bodies of the foot.

This article illustrates several case reports of occult foreign bodies of the foot. The patients came for treatment from weeks to years after the inciting incident with chronic, sterile, draining wounds. The diagnosis of these foreign bodies can be quite difficult. Several radiographic and clinical clues are included, yet the single most valuable tool for the physician remains a high index of suspicion.