Stress Fractures: Diagnosis and Management in the Primary Care Setting
Section snippets
Epidemiology
Snyder and colleagues43 extensively reviewed epidemiologic studies on stress fractures in athletes. It is difficult to generalize data from different studies because of methodological differences among them. Factors that influence the acquisition, results, and interpretation of data include differences in definition of injury exposure, study designs, definition of injury, and accuracy and method of diagnosis (clinical, radiological). Given these limitations, several conclusions are drawn.43
Diagnosis
Activity-related, insidious onset of pain that is localized to the affected area is the cardinal presenting symptom of stress fracture.1 Initially, the pain is reduced or transiently relieved with rest, allowing the athlete to continue the activity; however, progression of stress injury results in increased intensity of pain and functional deterioration or limitation of activity, which prompts the athlete to seek medical attention.6, 53, 54, 55 Pain from stress fracture is usually described as
Management
Management of stress fractures is guided by consideration of several factors. It is important to first recognize whether the fracture is at a high-risk (Box 1) or low-risk site (Table 5).2, 3 In general, when a high-risk stress fracture is suspected or identified, orthopedic or sports medicine consultation is recommended, although this decision may be tempered by personal experience of the primary care physician and the site and severity of the fracture. While awaiting further definitive
Summary
Stress fractures in adolescent athletes are common injuries seen in practice. Stress fractures most frequently affect lower extremities and are most common in long-distance runners and track and field athletes. Diagnosis is based mainly on clinical evaluation. MRI is the study of choice for further delineating the stress injury of the bone. Most stress fractures that involve low-risk sites can be managed conservatively in the primary care setting and heal in 6 to 10 weeks.
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2022, Disease-a-MonthCitation Excerpt :Most injuries can be successfully treated and result in minimal, if any complications. The potential serious complications include partial or complete growth arrest and angular deformity.261–264 The growth plate is also susceptible to stress injury from chronic repetitive microtrauma associated with intense training and sports participation.
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2017, Fracture Management for Primary Care Updated EditionHierarchies of damage induced loss of mechanical properties in calcified bone after in vivo fatigue loading of rat ulnae
2011, Journal of the Mechanical Behavior of Biomedical MaterialsCitation Excerpt :While serving this mechanical function, bone tissue is expected to accumulate damage due to the numerous interfaces and stress concentrations present in bone and because of complex loading modalities (George and Vashishth, 2005; Hazenberg et al., 2006; Pattin et al., 1996; Pidaparti et al., 2000). If this damage is not constantly detected and repaired, damage can accumulate and directly or indirectly lead to structural failure, clinically diagnosed as a stress fracture (Burr, 1993; Chapurlat and Delmas, 2009; Donahue and Galley, 2006; Patel, 2010). Damage can occur at multiple hierarchical scales upon loading of whole bone.
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