Taking a holistic approach to managing difficult stress fractures

Miller, Timothy L.; Best, Thomas M.

doi:10.1186/s13018-016-0431-9

Cited by 34 publications

(26 citation statements)

References 38 publications

(72 reference statements)

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“…Once the microdamage threshold range is exceeded, microdamage may occur. With a high workload, microdamage may accumulate and propagate stimulating bone resorption that may increase crack propagation with continued loading, resulting in stress fracture 11 37. As LSF is a gradual-onset injury,12 it is unlikely that symptoms will manifest immediately, so fast bowlers continue to bowl in a state of pathological overload, reflected in cases at the end of the season (figure 3D), where their 90-day workload was significantly greater than controls for the 81 days leading up to LSF.…”

Section: Discussionmentioning

confidence: 99%

“…Although only composing between 3% and 12% of all injuries in cricket,4 7–9 lumbar stress fracture (LSF) result in the greatest time loss of any injury suffered in cricket 4 6 7 10. LSF is a fatigue injury, caused by the accumulation and propagation of microdamage across the neural arch of the lumbar vertebra, at a rate greater than the repair processes of bone 11 12…”

Section: Introductionmentioning

confidence: 99%

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Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Alway

Brooke‐Wavell

Langley

et al. 2019

BMJ Open Sport Exerc Med

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ObjectivesSince much of the previous epidemiological research into lumbar stress fracture was conducted, there has been a marked increase in the amount of cricket being played. The aims were to determine the incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers between 2010 and 2016, determine the association with match bowling workload and observe seasonal variation in workload and injury.MethodsLumbar stress fracture incidence and prevalence rates were calculated using new international methods for epidemiology in 368 professional English fast bowlers from 2010 to 2016. Workload variables were compared between lumbar stress fracture case and non-injured control groups, before entry in a logistic regression.ResultsFifty-seven lumbar stress fractures (mean age 22.81) were reported. Injury was most common in July and September. Match incidence was 0.16 lumbar stress fractures per 10 000 deliveries, annual incidence was 2.46 lumbar stress fractures per 100 fast bowlers and annual prevalence of lumbar stress fractures was 1.67% of squad days. Significant workload variables were observed between cases and controls. A peak 7-day workload of greater than 234 deliveries significantly increased the odds of sustaining a lumbar stress fracture 11-fold compared with bowling fewer than 197 deliveries.ConclusionLumbar stress fractures are common in young fast bowlers possibly due to immaturity of the lumbar spine. The condensed early and late-season schedule may be causing periods of overuse, resulting in an increase in incidence of lumbar stress fracture. Reduction of workload in young fast bowlers is needed to reduce incidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Alway

Brooke‐Wavell

Langley

et al. 2019

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

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“…Vitamin K carboxylates the newly formed osteocalcin proteins, which are produced in mature bone cells and are strictly regulated by 25(OH)D [ 64 ]. Once the protein is carboxylated, it interacts with calcium ions in bone tissue [ 65 ] and has a significant impact on bone mineralization, bone formation, preventing bone loss and possibly preventing fractures in women [ 66 , 67 , 68 ]. However, osteocalcin production is not suppressed if the vitamin K levels are insufficient [ 69 ].…”

Section: The Importance Of 25(oh)d In Bone Metabolismmentioning

confidence: 99%

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

et al. 2021

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There are numerous risk factors for stress fractures that have been identified in literature. Among different risk factors, a prolonged lack of vitamin D (25(OH)D) can lead to stress fractures in athletes since 25(OH)D insufficiency is associated with an increased incidence of a fracture. A 25(OH)D value of <75.8 nmol/L is a risk factor for a stress fracture. 25(OH)D deficiency is, however, only one of several potential risk factors. Well-documented risk factors for a stress fracture include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, 25(OH)D deficiency, iron deficiency, menstrual disturbances, and inadequate intake of 25(OH)D and/or calcium. Stress fractures are not uncommon in athletes and affect around 20% of all competitors. Most athletes with a stress fracture are under 25 years of age. Stress fractures can affect every sporty person, from weekend athletes to top athletes. Stress fractures are common in certain sports disciplines such as basketball, baseball, athletics, rowing, soccer, aerobics, and classical ballet. The lower extremity is increasingly affected for stress fractures with the locations of the tibia, metatarsalia and pelvis. Regarding prevention and therapy, 25(OH)D seems to play an important role. Athletes should have an evaluation of 25(OH)D -dependent calcium homeostasis based on laboratory tests of 25-OH-D3, calcium, creatinine, and parathyroid hormone. In case of a deficiency of 25(OH)D, normal blood levels of ≥30 ng/mL may be restored by optimizing the athlete’s lifestyle and, if appropriate, an oral substitution of 25(OH)D. Very recent studies suggested that the prevalence of stress fractures decreased when athletes are supplemented daily with 800 IU 25(OH)D and 2000 mg calcium. Recommendations of daily 25(OH)D intake may go up to 2000 IU of 25(OH)D per day.

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“…Stress fracture is the result of an imbalance between bone formation and bone reabsorption during excessive, repetitive, dynamic cyclic loading. Multiple factors contribute to this condition including age, sex, race, nutritional behaviors, hormonal status, medication and tobacco use, bone structure, bone density, muscle length, muscle strength and tightness, joint range of motion, training volume, type of activity, training surface, shoes, and environmental conditions [ 5 , 6 ]. Younger age and intensive pre-season training are important risk factors.…”

Section: Introductionmentioning

confidence: 99%

Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report

2018

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BackgroundLeg pain in athletes is a common condition and is often related to tibial stress fracture. When non-operative treatment fails, the optimal surgical treatment is controversial. The aim of this study was to report a case of tension band plating of an anterior tibial stress fracture nonunion, treated previously with intramedullary nailing. To the best of our knowledge, this is the first reported case in which tension band plating was placed without removing the preexisting intramedullary nail.Case presentationThe tibial shaft is a common location of stress fracture in athletes. Anterior tibial stress fractures are difficult to manage. When conservative treatment fails, intramedullary nailing is the mainstay of treatment. However, nonunion is a serious complication. In our case, a non-united anterior tibial stress fracture, treated with intramedullary nailing, was addressed with the application of a compression prebended plate over the nail in a 23-year-old French man of African origin who is an elite football player. At 3-months postoperatively he was pain free and started light exercises. At 6-months postoperatively, complete radiologic union of the fracture was evident. He was symptom free; he resumed at that time a full training program and he returned to play football at preinjury high competition level.ConclusionsCompression plating is a valuable method of treating non-united anterior tibial stress fractures. We believe that anterior tension band plating is superior to intramedullary nailing in managing anterior tibial stress fractures, not only after failure of intramedullary nailing, but also as a first-line surgical treatment. This technique offers advantages, such as no violation of the extensor mechanism and risk of anterior knee pain, and directly addresses the underlying problem of distraction forces acting on the anterior tibial cortex and compromising fracture healing. Especially in high-level athletes, who cannot tolerate prolonged inactivity, early surgical intervention of anterior tibial stress fractures with tension band plating is a reliable option that can accelerate recovery.

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Taking a holistic approach to managing difficult stress fractures

Cited by 34 publications

References 38 publications

Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report

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