Treatment of Stress Fractures: The Fundamentals
Section snippets
Treatment principles
When considering treatment plans for a stress injury, one must understand why the injury occurs in the first place. Stress injuries occur when a physiologic load is placed on a bone in a repetitive fashion at a rate at which the body does not have time to recover. The load is considered insufficient to cause acute injury but, when combined with a cyclic pattern, can result in chronic injury. It is the “right” (or better stated, “wrong”) combination of load, repetition, and inadequate recovery
Training Regimen
An increase in activity is often the triggering event for a stress injury. Numerous military studies have shown the high rate of stress injury during basic training for which a progressive and demanding exercise regimen is required [14], [15], [16], [17], [18], [19], [20]. These military studies provide a relatively uniform patient population that, by order of the commanding officer, is highly compliant. When an increase in activity is noted in the patient's history, activity modification is
Anatomic Variation
Variations in anatomy have been implicated as a cause for lower-extremity stress fractures. An example of this is Morton's foot with a short, hypermobile first ray and a long second ray. In a study of second metatarsal fractures in ballet dancers by Khan and colleagues [31], six of the eight case reports were noted to have Morton's foot. Giladi and coworkers [32] reported the higher incidence of tibial stress fractures in male recruits who had greater passive external rotation of the hip
Ultrasound
A number of studies have shown that ultrasound is effective in reducing the healing time of acute fractures. In a prospective double-blind randomized study of 67 tibial shaft fractures, Heckman and colleagues [38] reported a significant decrease in healing time with the addition of ultrasound (86 ± 5.8 days versus 114 ± 10.4 days). Kristiansen and coworkers [39], in a prospective double-blind study of distal radius fractures, also noted a significant decrease in healing time (61 ± 3 days versus
High-risk stress fractures
Any treatment plan for stress fractures must also take into consideration the inherent and specific risk for further injury. It is helpful when devising a treatment plan to understand the difference between the “safe” and “high-risk” stress injury. A stress fracture may be considered higher risk if it has a high propensity to progress to a complete fracture. In addition, the morbidity associated with the completed or possibly displaced fracture must also be considered. Essentially, the higher
References (47)
Stress fractures in athletes
Nurs Clin North Am
(1991)- et al.
the female athlete triad: the interrelatedness of disordered eating, amenorrhea and osteoporosis
Clin Sports Med
(1994) Stress fractures
Clin Sports Med
(1987)- et al.
Risk factors for clinical stress fractures in male military recruits: a prospective cohort study
Bone
(2005) Zur pathologie des menschlichen fusses [To the pathology of the human foot]
Med Zeitung
(1855)Stress fractures of the tibia in athletes of ‘shin soreness’
J Bone Joint Surg [Br]
(1958)- et al.
Stress fractures of the femoral shaft in athletes—more common than expected: a new clinical test
Am J Sports Med
(1994) - et al.
The incidence and distribution of stress fractures in competitive track and field athletes
Am J Sports Med
(1996) - et al.
Stress fractures: a review of 180 cases
Clin Sports Med
(1996) - et al.
Spontaneous fractures of the humerus during pitching: a series of 12 cases
Am J Sports Med
(1992)
Olecranon stress fractures in throwers: a report of two cases and a review of the literature
Clin Orthop
Case report: clavicular stress fracture in a javelin thrower
Clin Sports Med
Stress fracture in the humerus in an adolescent tennis tournament player
Am J Sports Med
Stress fractures of the distal radius: a case report
Am J Sports Med
Stress fracture of the distal ulna: a case report
Clin Orthop
Stress fractures of the ulna in tennis players using a double-handed backhand stroke
Am J Sports Med
March fractures of the foot: care and management of 692 patients
Am J Surg
March fracture: a report of 307 cases and a new method of treatment
J Bone Joint Surg [Am]
Distribution and natural history of stress fractures in US Marine recruits
Radiology
Unusual distribution and onset of stress fractures in soldiers
Clin Orthop Rel Res
March fracture: an analysis of two hundred cases
AJR Am J Roentgenol
March fractures of the long bones of the lower extremities and pelvis
Am J Surg
Stress fractures: a preventable training injury
Mil Med
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2015, International Journal of SurgeryCitation Excerpt :However, in early stages it is the most specific and sensitive test available, as radiographic findings only appear after three weeks of the initial microfracture [27,79]. Treatment of stress fractures is based on a mechanical and a biological approach [72]. Load control on the mechanical side is the basic treatment, in order to allow the biological bone turnover to recover the stressed area.
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2012, Journal of UltrasoundCitation Excerpt :Computed tomography (CT) scan can show FF, but due to utilisation of radiation it is less favoured than the magnetic resonance imaging (MRI). MRI is the examination of choice in the early detection of SF but its use is limited by lack of access and associated cost [3]. In the past few years, various authors have reported ultrasound (US) as an inexpensive, non-invasive and ready modality with high sensitivity for the investigation of SF of the metatarsal [10,11].