Femoral diaphyseal stress fractures: results of a systematic bone scan and magnetic resonance imaging evaluation in 25 runners

Context:Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time.Evidence Acquisition:PubMed articles published from 1974 to January 2012.Results:Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis.Conclusions:These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports.

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“…Surgical intervention should be considered with displaced, delayed union, and nonunited fractures. 51 …”

Section: Specific Stress Fracturesmentioning

confidence: 99%

Stress Fractures of the Pelvis and Legs in Athletes

et al. 2012

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“…Previous reports in the literature support the use of this grading system in directing appropriate clinical management [4,7,8].…”

Section: Mri Grading Of Injuriesmentioning

confidence: 81%

“…Although femoral shaft stress fractures can occur at any site along the bone, the medial aspect of the proximal and middle thirds of the shaft appears to be particularly susceptible. It has been suggested that this predilection may relate to the biomechanical forces exerted on the bone during weight bearing and muscle exertion [4]. With weight bearing, the medial aspect of the femoral shaft is under compression and the lateral aspect is under tension.…”

Section: Pathophysiologymentioning

confidence: 99%

“…This model is borne out by our experience in evaluating femoral stress injuries by MRI in a population of highlevel runners. Most injuries were preferentially located along the medial femur, in the proximal and middle thirds of the shaft [4].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Radionuclide studies have high sensitivity, but they are limited by relatively poor specificity and lack of anatomic detail. MRI has emerged as the imaging technique of choice, providing excellent sensitivity and specificity [3,4]. In this pictorial essay, we present the spectrum of MRI findings seen with stress injuries of the femoral diaphysis, with particular attention to a grading system that can aid the clinician in designing a management plan tailored to each patient's specific injury.…”

mentioning

confidence: 99%

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