On the nature of stress fractures

Stanitski, Carl L.; McMaster, James H.; Scranton, Pierce E.

doi:10.1177/036354657800600615

Cited by 183 publications

(63 citation statements)

References 19 publications

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“…These figures must be seen in light of the fact that in four of these cases (all cases being located in the tibia), the initial treatment plan provided for the reduction of weightbearing on the extremity affected and the treatment was (2), while in those engaged in endurance sports (1) fractures in the metatarsal bones are most frequent. Only one patient engaged in a type of sport (bicycling) with little increased biomechanical stress on the lower extremity (3) switched to immobilization in a plaster cast because symptoms persisted. In one case-that of a tennis player with a fatigue fracture in the region of the olecranon-internal fixation with kirschner wires was carried out because there was a threat of dislocation, and the implant material was removed after 6 months, by the time a good clinical result of the treatment had been achieved.…”

Section: Therapy and Results Of Treatmentmentioning

confidence: 99%

“…In most studies, any patients with an immature skeletal system are just regarded as a subgroup of the overall patient population and not considered separately at all [3,8,[12][13][14][15][16]. Additionally, the population in these studies is heterogenous, as it includes athletes, patients with biomechanical abnormalities (i.e., patients with clubfoot) and even patients with ICP [17].…”

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confidence: 99%

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Stress fractures in adolescent competitive athletes with open physis

Niemeyer

Weinberg

Schmitt

et al. 2005

Knee Surg Sports Traumatol Arthr

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There have been no studies devoted exclusively to stress fractures in competitive athletes with immature skeletal systems so far. The object of this case series was to describe special features of stress fractures in athletes with immature skeletal systems, with special reference to sport-specific strain, diagnosis and treatment results. The study population was made up of 19 children and adolescents with a total of 21 stress fractures. The average observation period was 4.83 years [standard deviation (SD) 2.69] and the average age at diagnosis, 14.04 years (SD 4.7). The lower extremity was affected in most of our cases. In adolescent athletes, endurance sports appear to lead preferentially to stress fractures in the region of the metatarsal bones, while sports requiring sudden stops at high speed appear to increase the risk of fractures in the region of the tibial diaphysis (P=0.0322). Most (20 of 21) of the fractures in this study were treated conservatively with refraining from athletic activity and reduction of stress/weight-bearing for an average of 6.73 weeks (SD 2.91). In five cases the extremity was in addition immobilized in a plaster cast for 5.32 weeks (SD 2.21). Complete healing was achieved in 14 cases. In seven cases, however, the treatment did not lead to a satisfactory outcome. Most of the patients whose symptoms persisted over a long period had fractures in the tibia and were engaged in sports requiring frequent sudden stops. Our data suggest that stress fractures in athletes, whose skeletal systems are still immature, lead to a clinical picture that does not always culminate in a good outcome of treatment. We therefore recommend a thorough and early diagnostic investigation (including MRI) and consistent treatment whenever a patient's history and clinical picture give any indication that a stress fracture might be present.

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Section: Therapy and Results Of Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

Stress fractures in adolescent competitive athletes with open physis

Niemeyer

Weinberg

Schmitt

et al. 2005

Knee Surg Sports Traumatol Arthr

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“…In contrary Wagner et al [8] showed that the anterior aspect of the midshaft of the tibia is an area under tension than compression. Stanitsky et al [9] believes that concentrated muscle forces acting across a specifi c bone enhance the loading which occurs simply from direct weightbearing thus anterior cortex fractures of the tibia may be due to additional forces from the posterior muscle group causing increased anterior tension stress. As a consequence these lesions appear to be prone to delayed union or non union.…”

Section: Discussionmentioning

confidence: 99%

Anterior Tibial Cortex Stress Fracture in a High Demand Professional Soccer Player

Gigis

2011

J Med Cases

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Anterior tibia cortex consists a less common location stress fractures. Treatment and return-to-play decision making can have the greatest impact on an athlete's career. We report a case of a 33 years old high demand professional soccer player who suffered an anterior tibia cortex stress fracture. After a short period of conservative treatment we proceeded in an intramedullary nailing, drilling on the fracture site and insertion of autologous growth factors were performed in order to assisst the healing process. He returned to full activities (every day training and offi cial games) 9 weeks after the operation. The last radiograph 6 months post operatively showed healing of the fracture. We believe that intramedullary fi xation of anterior cortex tibial stress fractures when combined with drilling and the use of growth factors helps return sooner than expected to full preinjury levels of performance.

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“…Some investigators believe that muscles produce large strains in bone, especially at the muscle attachment points (29). This could potentially contribute to the occurrence of stress fractures in the upper body, such as at the ribs during rowing (25) and golfing (24), or in the humerus during throwing (23).…”

Section: Intrinsic Risk Factorsmentioning

confidence: 99%

Experimental validation of finite element predicted bone strain in the human metatarsal

Fung

Loundagin

Edwards

2017

Journal of Biomechanics

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The objective of this study was to verify and validate a finite element modeling routine for the human metatarsal, which is a common location for stress fractures. Experimental strain measurements on 33 human cadaveric metatarsals subject to cantilever bending were compared with strain predictions from finite element (FE) models generated from computed tomography images. For the material property assignment of the FE models, a published density-elasticity relationship was compared with density-elasticity equations developed using optimization techniques. The correlations between the measured and predicted and predicted strains were very high (r 2 ≥0.94) for all of the density-elasticity equations. However, the utilization of an optimized density-elasticity equation improved the accuracy of the finite element models, reducing the maximum error between measured and predicted strains by 10% to 20%. The finite element modeling routine could be used for investigating potential interventions to minimize metatarsal strains and the occurrence of metatarsal stress fractures.iii

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On the nature of stress fractures

Cited by 183 publications

References 19 publications

Stress fractures in adolescent competitive athletes with open physis

Stress fractures in adolescent competitive athletes with open physis

Anterior Tibial Cortex Stress Fracture in a High Demand Professional Soccer Player

Experimental validation of finite element predicted bone strain in the human metatarsal

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