Pathophysiology and Epidemiology of Stress Fractures

Breathnach, Oisín; Ng, Kelvin Tsun Wai; Spindler, Kurt P.; Wasserstein, David

doi:10.1007/978-3-030-46919-1_3

Cited by 2 publications

(11 citation statements)

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“…2,3,6 Bone stress injuries and/or fatigue fractures are often recognised in human sports activities, especially in runners and long-distance runners. 10,11 Microdamage formation as a consequence of repetitive mechanical loading is threshold-dependent and related to the number of bone strain cycles, strain magnitude and strain rate. [9][10][11] Microdamage is a natural phenomenon targeting remodelling of the bone but if insufficient time is given to adapt, then more damage may form before healing.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Microdamage formation as a consequence of repetitive mechanical loading is threshold-dependent and related to the number of bone strain cycles, strain magnitude and strain rate. [9][10][11] Microdamage is a natural phenomenon targeting remodelling of the bone but if insufficient time is given to adapt, then more damage may form before healing. 7,[9][10][11] For these reasons, bone stress injuries and/or fatigue fractures are considered overuse injury and it is unsurprising that they are recognised in endurance horses, who are subject to high amounts of repetitive loading necessary to reach an adequate level of metabolic and musculoskeletal training in terms of adaptation, as previously reported.…”

Section: Discussionmentioning

confidence: 99%

“…2,[4][5][6] Adaptive bone remodelling to exercise is normal but if the amount or intensity of exercise exceeds the bone capacity to remodel, non-adaptive remodelling (ie, stress reaction) of the bone can occur, leading to subchondral or cortical bone damage in long bones or injury of the compact and spongious bones in flat bones. [7][8][9][10][11] Ultrasonography is very sensitive to any alteration of the bone surface. 4 A bone stress injury can progress to fatigue fracture due to accumulated bone microdamage induced by repetitive loading with disturbance of remodelling, weakening of the bone and a resulting fracture.…”

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confidence: 99%

“…4 A bone stress injury can progress to fatigue fracture due to accumulated bone microdamage induced by repetitive loading with disturbance of remodelling, weakening of the bone and a resulting fracture. [7][8][9][10][11] Bone stress injuries and fatigue fractures are extensively reported in racehorses, especially in Thoroughbreds, at predilection sites, 12,13 where the most common location of fatigue fracture of the pelvis is the iliac wing and to a lesser extent the tuber coxae, the iliac shaft, pubis and ischium. [2][3][4][5][6]12,14,15 These pelvic fatigue fractures are rarely reported in Standardbred horses.…”

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Bone stress injuries and fatigue fractures of the pelvis in endurance horses

Puccetti

Beccati

Denoix

2021

Equine Veterinary Journal

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Background: Bone stress injuries and fatigue fractures of the pelvis are reported in only a small number of endurance horses.Objectives: To describe bone stress injuries and fatigue fracture of the pelvis in endurance horses trained and competing on the deep sand surfaces.Study design: Retrospective case series.Methods: Medical records of horses used for endurance and diagnosed with bone stress injuries and/or fatigue fractures of the pelvis by ultrasound were reviewed.The bone stress injuries and fatigue fractures were classified as affecting the iliac wing, the iliac shaft, the tuber ischiadicum, the rest of the ischium or the pubis and subdivided into four fracture configurations: isolated iliac fracture, isolated fracture of the floor of the pelvis, isolated tuber ischiadicum fracture and multiple fractures.Descriptive statistics were performed overall and on fracture configurations for age, sex, breed, level of activity, affected limbs, previous injuries, development of the injury, seasons in the UAE, physical and dynamic findings and outcome. For each fracture configuration and the outcome, multivariable logistic regression models were developed after univariable logistic regression and collinearity analyses. Significance was set at P ≤ .05.Results: Sixty endurance horses were included; 48% (95% CI: 36%-61%) had isolated iliac fracture, 17% (7%-26%) isolated fracture of the floor of the pelvis, 15% (6%-24%) isolated tuber ischiadicum fracture and 20% (10%-30%) had multiple fractures. Breed (OR, 4.42; 95%CI,) was significantly associated with isolated iliac fracture and asymmetry of bone landmarks (OR, 7.42; 95% CI, 1.47-37.45) with isolated tuber ischiadicum fracture. Degree of lameness (OR, 3.08; 95% CI, 1.07-8.9) and trotting on three tracks (OR, 8.62; 95% CI, 1.43-51.9) were significantly associated with the diagnosis of isolated fracture of the floor of the pelvis. Main limitations: Data acquired in a single country. Conclusions: Bone stress injuries and fatigue fractures of the pelvis can affect endurance horses trained and competing on deep sand. Isolated bone stress injuries and/ or fatigue fractures of the ileum were the commonest followed by multiple pelvic bones involvement. The presence of lameness and trotting on three tracks suggest the presence of bone stress injuries and/or fatigue fractures of the floor of the pelvis; asymmetry of bony landmarks is more commonly detected in horses with bone stress injuries and/or fatigue fractures of the tuber ischiadicum. | 1065 PUCCETTI ET al. | INTRODUC TI ONFractures of the equine pelvis usually have a low incidence but their recognition has increased recently with the improvement of the diagnostic procedures. [1][2][3][4][5] They can develop as the consequence of trauma but also as the result of repetitive load induced by the athletic activity, especially in racehorses, so they can be considered as a stress or fatigue fracture. 2,[4][5][6] Adaptive bone remodelling to exercise is normal but if the amount or intensity of exercise exceeds the bone capacit...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Bone stress injuries and fatigue fractures of the pelvis in endurance horses

Puccetti

Beccati

Denoix

2021

Equine Veterinary Journal

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“…In truth, bone modeling and remodeling are complex processes, especially when growth and exercise intersect. SF have been associated with normal remodeling and high strains, or normal strains with decreased remodeling [87]. Even though it is not clear what pathophysiological mechanism prevails in racehorses, any interruption in normal osteoclast resorption could be harmful and lead to damage accumulation over time.…”

Section: The Use Of Bisphosphonates In Young/exercising Animalsmentioning

confidence: 99%

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

Vergara-Hernandez

Nielsen

Colbath

2022

Animals

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Osteoclasts are unique and vital bone cells involved in bone turnover. These cells are active throughout the individual’s life and play an intricate role in growth and remodeling. However, extra-label bisphosphonate use may impair osteoclast function, which could result in skeletal microdamage and impaired healing without commonly associated pain, affecting bone remodeling, fracture healing, and growth. These effects could be heightened when administered to growing and exercising animals. Bisphosphonates (BPs) are unevenly distributed in the skeleton; blood supply and bone turnover rate determine BPs uptake in bone. Currently, there is a critical gap in scientific knowledge surrounding the biological impacts of BP use in exercising animals under two years old. This may have significant welfare ramifications for growing and exercising equids. Therefore, future research should investigate the effects of these drugs on skeletally immature horses.

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Pathophysiology and Epidemiology of Stress Fractures

Cited by 2 publications

References 56 publications

Bone stress injuries and fatigue fractures of the pelvis in endurance horses

Bone stress injuries and fatigue fractures of the pelvis in endurance horses

Is the Use of Bisphosphonates Putting Horses at Risk? An Osteoclast Perspective

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