Stress fracture

Common in sports injuries that involve prolonged walking, running, jumping.

Account for 0.7-20% of injuries in athletes, and involve multiple regions of the body.

Most frequent sites of stress fracture include: the tibia, metatarsals, and fibula.

Extrinsic risk factors include activity type, equipment utilized, all factors that influence the amount of mechanical stress.

Mechanical stress makes bones susceptible to micro fractures, which subsequently can develop into stress fractures as a result of repetitive stress injury.

The repetition of tensile or compressive forces and activities increases the magnitude or rate of bone loading that contributes to damage formation.

Mechanical stresses may be below the threshold for fracture, but repetition of such stresses may overcome the structural properties of the bone.

Occurs when the overuse of an extremity or other part of the body, particularly after minimal use.

Has chronic repetitive microtrauma that leads to a weakening and subsequent fracture of the bone.

Intrinsic factors refer to physiological characteristics and include sex, anatomy, hormone balance, obesity, bone health, and nutrition which influence how the bone response to mechanical stressors.

Mechanical injury risk are increased in females with abnormal eating disorders, menstrual dysfunction and low bone mineral density.

The “female athletic triad” refers to disordered eating, menstrual dysfunction and low bone mineral density in women.

Obesity increases the magnitude of bone loading doing activities and can increase the risk of stress fracture.

The key radiographs for diagnosis are plain films, because of availability, and low-cost.

Plain film x-Rays lack diagnostic sensitivity as they are normal for the first 2-3 weeks after symptom onset.

MRI studies are diagnostic if plain films are negative.

Radiographs show lucencies and cortical thickening.

NSAIDs may delay bone healing, and are relatively contraindicated.

Stress fractures require non-weight bearing immobilization.

Decreasing the extrinsic load by splinting, casting improves healing.

12 weeks is the minimum time for recovery.

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