OUTCOME AND FOLLOW-UP

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.