The patient was initially followed up by the orthopaedic
department and management conservatively and eventually discharged back
to the care of the GP and referred to the Rheumatology department for
further investigations. Primarly, the patient underwent blood tests to
rule out underlying metabolic pathologies. Bloods tests revealed a
vitamin D deficiency suggestive of ostemomalacia and the patient was
advised that he will be managed further by the Rheumatology team. As per
advice from the rheumatology team, the patient required a metabolic
screen to rule out underlying pathologies responsible for the occurence
of stress fracuters in an otherwise young, fit and well adult. Common
conditions such as ceoliac disease were to be investigated and ruled out
with anti-tissue transglutaminase and consideration for a duodenal
biopsy as the inability to adequately absorb nutrients from the gut
including calcium and vitamin D may lead osteomalacia. Further
differentials which needed investigation included congenital
hypogonadism which required a hormonal profile and hyperthyroidism which
require thyroid function tests as both conditions can be an underlying
cause of stress fractures in an otherwise well patient. More rare
differentials which were to be investigated included HIV and anorexia
nervosa, the latter which would require involvement of the psychiatric
team. The patient was discharged from orthopaedics and advised to
confirm his next outpatient appointment with the rheumatology which
unfortunately he failed to attend. |