Red flag triaging

• Red flags can include:

  • A history of cancer: Metastases or cancer present in the prostate, breast or hip and groin region
  • Infection: High fever, STI/UTI’s can cause hip and groin pain
  • Neurological: CES, Saddle anaesthesia, sexual dysfunction
  • Fractures: Trauma or overuse
• Triage – pathologies to consider:

  • Stress and insufficiency fractures
  • Neck of Femur fracture
  • Avascular necrosis of the femoral head
• Insufficiency fractures vs. stress fractures:

  • Stress: Overload in sports athletes
  • Insufficiency: Fracture in response to normal daily loading
  • Both: Atraumatic fracture / gradual onset
• Insufficiency fractures vs. stress fractures: Prevalent in:

  • women that are older than 50 years with Osteoporosis: Lack of vitamin D, calcium and bone turnover
  • Young – overload in training Runners, Base of 5th metatarsal 20%
  • Pelvic ring stress fractures common in women
• Insufficiency fractures vs. stress fractures: Common sites:

  • Pubic rami, Sacrum
• Insufficiency fractures vs. stress fractures: Contributing factors:

  • Mechanically weak bone (low bone density)
  • Diet and eating disorders (Calcium and Vitamin D)
  • Females: Relative Energy Deficiency in sport (RED-S)
  • Training errors / load
• Insufficiency fractures vs. stress fractures: Symptoms:

  • Pain with exercise, that stops at rest -> increased pain at earlier stage of exercises and takes longer to wean as fractures progresses
  • Localised tenderness
  • Xray / MRI if suspicious of fractures
• Insufficiency fractures vs. stress fractures: Treatment:

  • Rest/unload stress area
  • Ideally 4 - 12 weeks away from sport
  • Exercise readjustment
  • Orthopaedic referral