Stress fractures in athletes

Abstract

We analyzed cases of 320 athletes with bone scan-positive stress fractures (M = 145, F = 175) seen over 3.5 years and assessed the results of conservative management. The most common bone injured was the tibia (49.1%), followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%). Stress fractures were bilateral in 16.6% of cases. A significant age difference among the sites was found, with femoral and tarsal stress fractures occurring in the oldest, and fibular and tibial stress fractures in the youngest. Running was the most common sport at the time of injury but there was no significant difference in weekly running mileage and affected sites. A history of trauma was significantly more common in the tarsal bones. The average time to diagnosis was 13.4 weeks (range, 1 to 78) and the average time to recovery was 12.8 weeks (range, 2 to 96). Tarsal stress fractures took the longest time to diagnose and recover. Varus alignment was found frequently, but there was no significant difference among the fracture sites, and varus alignment did not affect time to diagnosis or recovery. Radiographs were taken in 43.4% of cases at the time of presentation but were abnormal in only 9.8%. A group of bone scan-positive stress fractures of the tibia, fibula, and metatarsals (N = 206) was compared to a group of clinically diagnosed stress fractures of the same bone groups (N = 180), and no significant differences were found. Patterns of stress fractures in athletes are different from those found in military recruits. Using bone scan for diagnosis indicates that tarsal stress fractures are much more common than previously realized. Time to diagnosis and recovery is site-dependent. Technetium99 bone scan is the single most useful diagnostic aid. Conservative treatment of stress fractures in athletes is satisfactory in the majority of cases.

Unusual Clinical Presentation of Stress Fracture

“…The particularity of our observation is its aetiology and the fact that the fracture was bilateral.Matheson [5] estimated that only 16% of stress fractures are bilateral. Rare are the publications about this subject and none advanced an explanation for the double fracture.…”

Stress fractures in the foot and ankle of athletes

“…2 Stress injuries are common among athletes and military recruits, accounting for approximately 10% of all orthopedic injuries. 3 It is defined as a solution for partial or complete continuity of a bone as a result of excessive or repeated loads, at submaximal intensity, resulting in greater reabsorption faced with an insufficient formation of bone tissue. 1 Although stress fractures may affect all types of bone tissue, they are more common in bones that support bodyweight, especially those in the lower limbs (tibia, 49%; tarsal bones, 25%; metatarsals, 9%).…”

“…1 Although stress fractures may affect all types of bone tissue, they are more common in bones that support bodyweight, especially those in the lower limbs (tibia, 49%; tarsal bones, 25%; metatarsals, 9%). 3 Studies on runners reveal a higher incidence of stress fractures in the tibia, followed by the metatarsals, fibula, femur and navicular bone. 4,5 The locations of stress fractures vary from sport to sport.…”

“…A gradual return to the sport is allowed based on the correction of intrinsic and extrinsic factors (D). 3 Most stress fractures can be treated conservatively. This implies immobilization in a boot, without sustaining the foot until the symptoms have disappeared, generally around 6 to 8 weeks.…”

Bilateral stress fracture of the tibia diagnosed by ultrasound. A case report

“…Although they can affect the upper extremity, FF mostly involve the lower extremity with prevalence for the tibia, the neck of the femur, the metatarsal bones and the calcaneus [1,2,6,7]. Patients present with local pain typically accentuated by activity and diminished by rest.…”