Analysis of stress fractures in athletes based on our clinical experience

Abstract

AIM:To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS:We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS:During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION:The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

RANK/RANKL/OPG pathway: Genetic associations with stress fracture period prevalence in elite athletes

“…Stress fracture period prevalence in the present study (24.9% in the entire group) was higher than previously reported (0.5% in elite football players; 38), although this might be due to the fact that participation may have been more likely if there was a history of stress fracture injury within their own organisation/club. The predominant site of stress fracture was in the lower limb (56.8%), which is consistent with previously published data concerning athletes (30).…”

“…Although not associated with stress fracture injury in the present study, bone phenotypic associations with rs9594738 have been shown. However, these have been in areas mainly consisting of trabecular bone, whereas stress fractures in athletes occur predominantly in the tibial diaphysis and metatarsals (30), sites mainly comprised of cortical bone. The influence of exercise on the RANK/RANKL/OPG signalling pathway, circulating RANKL and OPG concentrations and RANK density may also introduce confounding effects.…”

Experimental and finite element analysis of tibial stress fractures using a rabbit model

“…Most commonly sustained in the tibia, stress fractures are debilitating injuries, often requiring weeks to months of rest and rehabilitation. Despite various interventions introduced in order to mitigate the risk of stress fractures, athletes [1][2][3] and military recruits [4,5] continue to be susceptible to these injuries due to their intense training regimes.…”

Stress Fracture

“…In studies of military populations, the rate ratio has been reported as high as 10 to 1 [ 8 -12 ], with up to 20 % of female recruits in basic training sustaining a stress fracture [ 9 -13 ]. In the broader population of ambulatory adolescents and young adults, no such gender difference has been noted [ 14 ]. Otherwise, studies in adult populations have shown increased prevalence with age [ 8 , 11 ], and Caucasian or Asian ethnicity [ 11 ].…”