Stress Fractures
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Definition/Description[edit | edit source]
Stress fractures represent a spectrum of injuries ranging from periostitis, caused by inflammation of the periosteum, to a complete stress fracture that includes a full cortical break. They are relatively common overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time and are often seen in running and jumping athletes and are associated with increased volume or intensity of training workload. Most common in the lower extremities and are specific to the sport in which the athlete participates. Upper extremity stress injuries (usually of ulna) are much less common and similar to the lower extremity injuries, upper extremity stress injuries are the result of overuse and fatigue.[1] This great 6 minute video sums up stress fractures.
Pathophysiology[edit | edit source]
Healthy bone is in constant homeostasis between microcrack creation and repair. Fatigue failure of the bone has three stages: crack initiation, crack propagation, and complete fracture. Crack initiation typically occurs at sites of stress concentration during bone loading. Crack propagation occurs if loading continues at a frequency or intensity above the level at which new bone can be laid down and microcracks repaired. Continued loading allows for the coalescence of multiple cracks to the point of becoming a clinically symptomatic stress fracture. If the loading episodes are not modified or the reparative response is not increased the stress fracture can continue until structural failure or complete fracture occurs.[3]
Epidemiology /Etiology[edit | edit source]
Stress fractures are the partial or complete fracture of a bone as a result of sub-maximal loading. Normally, submaximal forces do not result in the fracture but with repetitive loading and inadequate time for healing and recovery, stress fractures can potentially occur. It still is unknown if the cause is contractile muscle forces acting on a bone or increased fatigue of supporting structures; it is likely that both contribute.
- Up to 20% of all sports medicine clinic injuries may be related to stress injuries[1]
- Stress fractures are more common in weight-bearing than non-weight bearing limbs. Stress fractures of the tibia, metatarsals, and fibula are the most frequently reported sites. Medial tibial stress syndrome, also known as shin splints, is the most common form of early stress injury. This diagnosis reflects a spectrum of medial tibial pain in early manifestations before developing into a stress fracture.
- The location of stress injuries varies by sport. Among 1. track athletes - fractures to the navicular, tibia, and metatarsals are most common. 2 distance runners - the tibia and fibula are most common. 3 dancers - the metatarsals are most afflicted.4. military recruits- calcaneus and metatarsals are the most commonly fractured site. The ulna is the upper extremity bone most frequently affected.[1]
Women experienced stress fractures at higher rates than men, more often in the preseason, and predominantly in the foot and lower leg[4].
Characteristics/Clinical Presentation[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Kiel J, Kaiser K. Stress reaction and fractures. InStatPearls [Internet] 2019 Jun 4. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507835/ (last accessed 30.11.2019)
- ↑ Ohio state medical centre Stress Fractures, Explained by Ohio State Sports Medicine Available from: https://www.youtube.com/watch?v=AVS99bCKwzQ (last accessed 30.11.2019)
- ↑ Miller TL, Best TM. Taking a holistic approach to managing difficult stress fractures. Journal of orthopaedic surgery and research. 2016 Dec;11(1):98. Available from: https://josr-online.biomedcentral.com/articles/10.1186/s13018-016-0431-9 (last accessed 30.11.2019)
- ↑ Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The epidemiology of stress fractures in collegiate student-athletes, 2004–2005 through 2013–2014 academic years. Journal of athletic training. 2017 Oct;52(10):966-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28937802 (last accessed 30.11.2019)
