Keywords:
Bones, Extremities, Musculoskeletal system, MR, Plain radiographic studies, CT, Education, Athletic injuries, Osteoporosis
Authors:
E. Tavernaraki1, V. Bizimi1, V. Vantali1, V. Papalouka2, D. Chondros1, O. Papakonstantinou1; 1Athens/GR, 2Chaidari/GR
DOI:
10.1594/essr2015/P-0012
Background
Stress fractures are overuse injuries as the result of repetitive load in healthy bones (fatigue fractures) or in abnormal bone (insufficiency fractures).It is a result of imbalance between osteoblast and osteoclasts due to <<remodeling>> of repetitive <<stress>> in bone.
Insufficiency fractures are generally seen in elderly and more frequently in women,
in the setting of osteoporosis.
Common locations include vertebra,
sacrum,
neck of femur,
pubic rami.
Causes are osteoporosis,
radiation,
steroids ,
hyperparathyroidism,
rheumatoid arthritis,
osteomalakia,
Diabetes,
Paget,
Osteogenesis Imperfecta and tumor.
Fatigue fractures are usually in young active patients of mean age 19-30 yrs.
In females it occurs 1.5-3.5 times more than males.
Frequency in athletes is 0.2-49%.Lower extremity bones such as tibia,
metatarsal bones,
femoral neck are the most common locations (table 1). Stress fractures occur when athletic activity increases or changes in short time.
Common related causes are unsuitable shoes or training surface,
wrong training technique,
metabolic disorders,
low estrogen level and nutritional disorders.
Clinical findings: Insidious onset of local pain without any history of trauma.
At beginning pain is in the end of athletic activity and relieves at rest.
If activity continuous,
pain forces athlete to stop activity.
With increased severity of injury,
the pain may persist at rest.
Physical examination findings are pain at palpation,
redness and swelling.
table 1
SPORT |
STRESS FRACTURE |
Long distance running
|
Tibia,
fibula
|
track
|
Tibia,
metatarsals,scaphoid bone
|
gymnastics
|
Tibia,
ischial ramus
|
Basket,
handball
|
Metatarsals,
scaphoid bone
|
Weight lifting,
diving
|
Lumbar spine
|