- Discussion:
- occur as the result of repetitive loading below yeild strength & are most common in lower extremity (
metatarsals >
calcaneus >
tibia);
- Matheson et al.: 370 athletes with stress fractures tibia (49.1%), tarsals (25.3%), metatarsals (8.8%) and bilateral stress fractures in 16.6% of cases;
- focal structural & muscle weakness & repetitive muscle pull are common;
- common in athletes, esp in white women, with advancing age, and w/ underlying
metabolic bone diseases;
-
differential dx:
- predisposing factors:
- menstrual irregularity,
osteoporosis, diabetic or idiopathic neuropathy, smoking and alcohol intake, hypothyroidism, anorexia nervosa,
Paget's disease, and
rheumatoid arthritis;
- progression of stress fractures:
- stage I - crack initiation: areas of stress concentration
- stage II - crack propagation: no repair or more damage than repair
- stage III - final fracture: cracks coalesce, enlarge, ultimate failure
-
history:
- 1855 – Breithaupt described foot pain and swelling in military recruits
- 1897 – Stechow recognized “march fracture” on radiographs
- 1921 – Deutschlander reported six cases in civilian women
- 1956 – Devas and Sweetnam noted fibula stress fractures in athletes
- Work Up:
- endocrine considerations:
- menstrual irregularity
-
hyperparathyroidism (need to r/o
hypercalcemia);
- bone density study: (
dual X-ray absorptiometry);
- Specific Types of Stress Frx:
-
sacral stress fractures:
- references:
-
Jogger's fracture and other stress fractures of the lumbo-sacral spine.
-
pubic stress frx:
- patients will note groin pain;
- diff dx includes hernia and partial avulsion of the rectus abdominus;
- bone scan may assist in the diagnosis;
- references:
-
Stress fractures of the pubic ramus. A report of twelve cases.
- Osteitis pubis in athletes: Infection, inflammation or injury? PA Fricker et al.
Sports Med. Vol 12. 1991. p 266-279.
-
Abdominal musculature abnormalities as a cause of groin pain in athletes.
- Osteitis pubis, Tc 99m, and professional hockey players. RC Briggs et al.
Clin. Nucl. Med. Vol 17. 1992. p 861-863.
-
femoral neck stress frx:
-
tibial stress frx
-
shin splints:
- references:
-
An analysis of the biomechanical mechanism of tibial stress fractures among Israeli infantry recruits. A prospective study.
-
Clinical significance of nonfocal scintigraphic findings in suspected tibial stress fractures.
-
Medial tibial pain. A prospective study of its cause among military recruits.
-
foot and ankle stress frx:
- risk factors: pronated feet,
cavus feet, and increased external tibial torsion are common risk factors;
- specific types of frx:
- distal fibular and medial malleolar frx: uncommon but do occur;
-
calcaneal fatigue fractures:
-
forefoot & midfoot stress frx
-
navicular stress frx:
-
metatarsal stress frx:
- references:
-
Diagnostic dilemmas in foot and ankle injuries.
-
Stress fracture of the medial malleolus.
- Fatigue fractures of the foot and ankle in the athlete. SA Eisele et al JBJS. Vol 75-A. No 2. Feb 1993. p 290-298.
- Insufficiency stress fractures of the foot and ankle in postmenopausal women. RA Kaye MD
Foot and Ankle International. Vol 19. No 4. Arp 1998. p 221.
Review Article: Stress Fractures: Current Concepts.
The long-term followup of soldiers with stress fractures.
Recurrent stress fractures in military recruits. One-year follow-up of 66 recruits.
External rotation of the hip. A predictor of risk for stress fractures.
The effect of pretraining sports activity on the incidence of stress fractures among military recruits. A prospective study.
Stress fractures in young athletes.
Stress Fractures around the Knee in Elderly Patients. A Cause of Acute Pain in the Knee.
MRI in stress fracture.
SA Stafford et al.
AJR. Vol 147. 1986. p 553-556.
