Introduction - Fracture of Pars interarticularis (Narrow isthmus of bone that lies between the two articulating facets - one superior and and one inferior)
- Usually childhood fracture
- Usually in Lumber spine
- Common in sports that require episodes of Hyperextension, especially if combined with rotation. Eg; of common sports - Gymnastics, fast bowling (cricket), Tennis, rowing, dance, weightlifting, wrestling, pole vaulting and high jump and throwing activites
- Usually at opposite side of activity (that is; In right handed person, fracture is common seen in Left).
Clinical Features - Unilateral low back pain, occasionally associated with somatic buttock pain
- Aggravated by movements involving hyperextension of lumber spine
- Occasionally asymptomatic
O/E - Pain maybe reproduced by hyperextension with rotation of Lumber spine
- And on extension while standing on the affected leg.
- Associated hamstrings spasm with excessive lordosis may present
- Tender over fracture site
Diagnosis - Xray - maybe normal (or) may showScotty dog appearance of a pars defect in Long stranding fracture
- If Xray Normal, SPECT scan to detect active stress fracture or stress reaction (Increase bone uptake)
- If SPECT positive - CT (reverse gantry) - to detect fracture line
- Alternatively - MRI can be used (not as sensitive as combined use of SPECT and CT)

Stages (by Radiology images) - Early - Focal bone absorption or Hairline defect
- Progressive - Wide defect and small fragments
- Terminal - Sclerotic changes
Prognosis - Early and half of progressive type achieved radiological healing
- Terminal cases - will not heal
- L4 fracture is better chance of healing than in L5
Management - Initially - Rest and avoid aggravating movment (ie; lumber extension and rotatoin)
- There is no definitely time set period to rest. PAIN should be used as a guide
- Rehab program aims at painfree progressive exercises
- When there is no longer local tenderness and aggravating activity is none tender, gradually resume the aggravating activity over 4 - 6 weeks.
Other Management - Specific exercise program training on Transverse abdominus and Multifundus (O'Sullivan et al's)
- Core stability exercises
- Assessment and modification of biomechanics and technique
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