Stress fractures. Current concepts of diagnosis and treatment

Sports Medicine

Volumn 22, Issue 3, 1996, Pages 198-212

  Reeder, Michael T ^a,b   Dick, Bruce H ^a   Atkins, Julia K ^a   Pribis, Anneke B ^a   Martinez, John M ^a  

^a ALBANY MEDICAL COLLEGE   (United States)

^b W Orthopaedics and Sports Medicine   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMENORRHEA; ATHLETE; BONE BOWING; BONE SCINTISCANNING; BRACE; CLINICAL EXAMINATION; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC IMAGING; DISEASE ASSOCIATION; ELECTROMAGNETIC FIELD; EXERCISE; FEEDING DISORDER; FEMALE; HUMAN; IMMOBILIZATION; LEG FRACTURE; MALE; NUCLEAR MAGNETIC RESONANCE IMAGING; OSTEOPOROSIS; REST; REVIEW; RUNNING; SEX DIFFERENCE; SHOE; STRESS FRACTURE; TRAINING; X RAY ANALYSIS;

EID: 0029780784     PISSN: 01121642     EISSN: None     Source Type: Journal    
DOI: 10.2165/00007256-199622030-00006     Document Type: Review

References (109)

1. Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes: a study of 320 cases. Am J Sports Med 1987; 15 (1): 46-58
2. McBryde AM. Stress fractures in athletes. J Sports Med 1975; 3: 212-7
3. Devas MB. Stress fracture of the tibia in athletes or 'shin soreness'. J Bone Joint Surg Am 1958; 40B: 227-36
4. Sullivan D, Warren RF, Pavlov H, et al. Stress fractures in 51 runners. Clin Orthop 1984 Jul/Aug; 187: 188-92
5. Zelko RR, DePalma BF. Stress fractures in athletes: diagnosis and treatment. Postgrad Adv Sports Med 1986; 1-20
6. Daffner RH, Martinez S, Gehweiler JA. Stress fractures in runners. JAMA 1982 Feb; 247 (7): 1039-41
7. Uhmans H, Pavlov H. Stress fractures of the lower extremity. Semin Roentgenol 1994 Apr; XXIX (2): 176-93
8. Koltmeier SA, Hanks GA, Kalenak A. Fibular stress fracture associated with distal tibiofibular synostosis in an athlete. Clin Orthop 1992; 281: 195-8
9. Reider B, Falconiero R, Yurkofsky J. Nonunion of a medial malleolus stress fracture. Am J Spoils Med 1993; 21 (3): 478-81
10. Kadel NJ, Teitz CC, Kronmal RA. Stress fractures in ballet dancers. Am J Sports Med 1992; 20 (4): 445-9
11. Leinberry CF, McShane RB, Stewart WG, et al. A displaced subtrochanteric stress fracture in a young amenorrheic athlete. Am J Sports Med 1992; 20 (4): 485-7
12. Orava S, Karpakka J, Taimela S, et al. Stress fracture of the medial malleolus. J Bone Joint Surg Am 1995 Mar; 77-A (3): 362-5
13. Strudwick WJ, Goodman SB. Proximal fibular stress fracture in an aerobic dancer: a case report. Am J Sports Med 1992; 20 (4): 481-2
14. Tanabe S, Nakahira J, Bando E, et al. Fatigue fracture of the ulna occurring in pitchers of fast-pitch softball. Am J Sports Med 1991; 19 (3): 317-21
15. Loosli AR, Leslie M. Stress fracture of the distal radius, a case report. Am J Sports Med 1991; 19 (5): 523-4
16. Nuber GW, Diment MT. Olecranon stress fractures in throwers. Clin Orthop 1992 May; 278: 58-61
17. Holden DL, Jackson DW. Stress fracture of the ribs in female rowers. Am J Sports Med 1985; 13 (5): 342-7
18. Alfred RH, Belhobek G, Bergfeld JA. Stress fractures of the tarsal navicular: a case report. Am J Sports Med 1992; 20 (6): 766-8
19. Schils J, Hauzeur J. Stress fracture of the sacrum. Am J Sports Med 1992; 20 (6): 769-70
20. Yasuda T, Miyazaki K, Tuda K, et al. Stress fracture of the right distal femur following bilateral fractures of the proximal fibulas: a case report. Am J Sports Med 1992; 20 (6): 771-4
21. Black KP, Ehlart KJ. A stress fracture of the lateral process of the talus in a runner: a case report. J Bone Joint Surg Am 1994; 76-A (3): 441-3
22. Atwell EA, Jackson DW. Stress fractures of the sacrum in runners. Am J Sports Med 1991; 19 (5): 531-3
23. Teitz CC, Harrington RM. Patellar stress fracture. Am J Sports Med 1992; 20 (6): 761-5
24. Ward WG, Bergfeld JA, Carson WG. Stress fracture of the base of the acromial process. Am J Sports Med 1994; 22 (1): 146-7
25. Bollen SR, Robinson DG, Crichton KJ, et al. Stress fractures of the ulna in tennis players using a double-handed backhand stroke. Am J Sports Med 1993; 21 (5): 751-2
26. Rettig AC, Beltz HF. Stress fracture in the humerus in an adolescent tennis tournament player. Am J Sports Med 1985; 13 (1): 55-8
27. Khan KM, Fuller PJ, Brukner PB, et al. Outcome of conservative and surgical management of naviculur stress fracture in athletes. Am J Sports Med 1992; 20 (6): 657-66
28. Bennell KL, Malcolm SA, Thomas SA, et al. The incidence and distribution of stress fractures in competitive track and field athletes. A twelve-month prospective study. Am J Sports Med 1996; 24 (2): 211-7
29. Brukner P, Bradshaw C, Khan KM, et al. Stress fractures: a review of 180 cases. Clin J Sports Med 1996; 6 (2): 85-4
30. Greaney RB, Gerber FH, Laughlin RL, et al. Distribution and natural history of stress fractures in US Marine recruits. Radiology 1983; 146: 339-46
31. Frederichson M, Bergman AG, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintography with a new MRI grading system. Am J Sports Med 1995; 23 (4): 472-81
32. Stanitski CL, McMaster JH, Scranton PE. On the nature of stress fractures. Am J Sports Med 1978; 6 (6): 391-6
33. Pester S, Smith PC. Stress fractures in the lower extremities of soldiers in basic training. Orthop Rev 1992 Mar; 21 (3): 297-303
34. Hulkko A, Orava S. Stress fractures in athletes. Int J Sports Med 1987; 8 (3): 221-6
35. Plasschaert VF, Johansson CG, Micheli LJ. Anterior tibial stress fracture treated with intramedullary nailing: a case report. Clin J Sport Med 1995; 5 (1): 58-62
36. Mendez AA, Eyster RL. Displaced nonunion stress fracture of the femoral neck treated with internal fixation and bone graft a case report and review of the literature. Am J Sports Med 1992; 20 (2): 230-3
37. Scully TJ, Besterman G. Stress fracture: a preventable training injury. Mil Med 1982 Apr; 147: 285-7
38. Sallis RE, Jones K. Stress fractures in athletes. Postgrad Med 1991 May; 89 (6): 185-92
39. Park JB. Biomaterials science and engineering. New York: Plenum Press, 1984
40. Rockwood CA, Green DP. Fractures in adults. Philadelphia: J.B. Lippincott Co., 1991: 1-8
41. Giladi M, Milgrom C, Simkin A, et al. Stress fractures identifiable risk factors. Am J Sports Med 1991; 19 (6): 647-52
42. Junqueira LC, Carneiro J, Kelley RO. Basic histology. Norwalk (CT): Appleton & Lauge, 1992
43. Johnson LC. Morphologic analysis in pathology in bone biodynamics. In: Frost HM, editor. Bone dynamics. Boston: Little, Brown & Co., 1963: 535-49
44. McBryde AM. Stress fractures in runners. In: D'Ambrosia R, Drez Jr D, editors. Prevention and treatment of running injuries. Thorofare (NJ): Charles B. Slack Inc., 1982: 21-42
45. Johnson AW, Weiss CB, Wheeler DL. Stress fractures of the femoral shaft in athletes more common than expected: a new clinical test. Am J Sports Med 1994; 22 (2): 248-56
46. Devas M. Ullrasonic assessment of stress fractures BMJ 1983 May; 286 (5): 1479-80
47. Savoca CJ. Stress fractures: a classification of the earliest radiographic signs. Radiology 1971; 100: 519-24
48. Bradshaw C, Khan KM, Brukner P. Stress fracture of the body of the talus in athletes demonstrated with computer tomography. Clin J Sports Med 1996; 6(1): 48-51
49. Wilcox Jr JR, Moniot AL, Green JP. Bone scanning in the evaluation of exercise related stress injuries. Radiology 1977; 123: 699-703
50. Prather JL, Nusynitz ML, Snowdy HA, et al. Scintographic findings in stress fractures. J Bone Joint Surg 1977; 59: 869-74
51. Taunton JE, Clement DB, Webber D. Lower extremity stress fractures in athletes. Physician Sports Med 1981 Jan; 9 (1): 77-86
52. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987 Apr; 28 (4): 452-7
53. Steinbronn DJ, Bennett GL, Kay DB. The use of magnetic resonance imaging in the diagnosis of stress fractures of the foot and ankle: tour case reports. Foot Ankle 1994; 15: 80-3
54. Burton EM, Amaker BH. Stress fracture of the great toe sesamoid in a ballerina: MRI appearance. Pediatr Radiol 1994; 24: 37-8
55. Saifuddin A, Chalmers AG, Butt WP. Longitudinal stress fractures of the tibia: MRI features in two cases. Clin Radiol 1994; 49: 490-5
56. Schils JP, Andrish JT, Piraino DW, et al. Medial malleolar stress fractures in seven patients: review of the clinical and imaging features. Radiology 1992; 185: 219-21
57. Laroche M, Rousseau H, Jacquemier JM, et al. Unusual stress fracture on the roof of the acetabulum: magnetic resonance imaging. J Rheumatol 1991; 18: 115-6
58. Lee JK, Yao L. Stress fractures: MR imaging. Radiology 1988; 169: 217-20
59. Stafford SA, Rosenthal D, Gebhardt MC, et al. MRI in stress fracture. Am J Radiol 1986; 147: 553-6
60. Yao L, Lee JL. Occult intraosseus fracture: assessment with MR imaging. Radiology 1987; 164: 763-6
61. Orava S, Karpakka J, Hulkko A, et al. Diagnosis and treatment of stress fractures located at the mid-tibial shaft in athletes. Int J Sports Med 1991; 12 (4): 419-22
62. Dale PA, Brook JT, Kelly PJ. Fracture healing with elevated venous pressure. 35th Annual Meeting ORS; 1989 Feb 6-9; Lus Vegas
63. Whitelaw GP, Wetzler MJ, Levy AS, et al. A pneumatic leg brace for the treatment of tibial stress fractures. Clin Orthop 1991 Sep; 270: 301-5
64. Dickson TB, Kichline PD. Functional management of stress fractures in female athletes using a pneumatic leg brace. Am J Sports Med 1987; 15 (1): 86-9
65. Bergfeld JA, Khoury M. Stress fractures in sports. Sports Medicine Symposium: 1994 Sep 14-16; Burlington (VT). Vermont: University of Vermont, 1994: 144-65
66. Bassett CAL, Mitchell SN, Gaston SR, et al. Treatment of ununited tibial diaphyseal fractures with pulsing electromagnetic fields. J Bone Joint Surg Am 1981; 63A: 511-23
67. Bassett CAL, Mitchell SN, Gaston SR. Pulsing electromagnetic field treatment in ununited fractures and failed arthrodeses. JAMA 1982; 247: 623-8
68. Rettig AC, Shelbourne KD, McCarroll JR, et al. The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia. Am J Sports Med 1988; 16 (3): 250-5
69. Brahms MA, Fumich RM, Ippolito VD. Atypical stress fractures of the tibia in a professional athlete. Am J Sports Med 1980; 8: 131-2
70. Green NE, Rogers RA, Lipscomb AB. Nonunions of stress fractures of the tibia. Am J Sports Med 1985; 13 (3): 171-6
71. Pribis AB, Reeder MT, Dick BD. Anterior tibial stress fracture progressing to complete fracture: a case report [abstract no. 30]. Med Sci Sports Exerc 1996; 28 Suppl.: S5
72. Barrick EP, Jackson CB. Prophylactic intramedullary fixation of the tibia for stress fractures in a professional athlete. J Orthop Trauma 1992; 6 (2): 241-4
73. Hershman EB, Lombardo J, Bergfeld JA. Femoral shaft stress fractures in athletes. Clin Sports Med 1990; 9 (1): 111-9
74. Johansson C, Ekenman I, Tornkvist H, et al. Stress fractures of the femoral neck in athletes. Am J Sports Med 1990; 18 (5): 524-8
75. Bellah RD, Summerville DA, Treves ST, et al. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology 1991; 180: 509-12
76. Micheli LJ. Low back pain in the adolescent: differential diagnosis. Am J Sports Med 1979; 7 (6): 362-4
77. Letts M, Smallman T, Afanasiev R, et al. Fracture of the pars interarticularis in adolescent athletes: a clinical biomechanical analysis. J Pediatr Orthop 1986; 6: 40-6
78. Drinkwater BL, Nilson K, Chesnut CH, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med 1984; 311: 277-80
79. Skolnick AA. 'Female athlete triad' risk for women. JAMA 1993; 270: 921-3
80. Nativ A, Agostini R, Drinkwater B, et al. The female athlete triad: the inter-relatedness of disordered eating, amenorrhea, and osteoporosis. Clin J Sport Med 1994; 13 (2): 405-18
81. Dummer GM, Rosen LW, Heusner WW. Pathogenic weight-control behavior of young competitive swimmers. Physician Sports Med 1987; 15: 75-86
82. Rosen LW, Hough DO. Pathogenic weight control behaviors of female college gymnasts. Physician Sports Med 1988; 16: 141-6
83. Rosen LW, McKeag DB, Hough DO, et al. Pathogenic weight control behaviors of female college athletes. Physician Sports Med 1986; 14: 79-86
84. Squire DL. Female athletes. Pediatr Rev 1987; 9 (6): 183-90
85. Walberg JL, Johnson CS. Menstrual function and eating behavior in female elite athletes. Med Sci Sports Exerc 1991; 23: 30-6
86. Johnson MD. Disordered eating in active and athletic women. Clin J Sport Med 1994; 13 (2): 355-69
87. Malina RM, Spirduso W, Tate C, et al. Age at menarche and selected menstrual characteristics in athletes at different competitive levels and in different sports. Med Sci Sports 1978; 10 (3): 218-22
88. Warren MP. The effects of exercise on pubertal progression and reproductive function in girls. J Clin Endocrinol Metab 1980; 51 (5): 1150-7
89. Erdelyi GJ. Effects of exercise on the menstrual cycle. Physician Sports Med 1976; 4: 79-84
90. Speroff L, Redwine DB. Exercise and menstrual function. Physician Sports Med 1980; 8: 42-9
91. Baker ER, Mather RS, Kirk RF, et al. Female runners and secondary amenorrhea: correlation with age, parity, mileage, and plasma hormonal and sex-hormone-binding globulin concentrations. Fertil Steril 1981; 36 (2): 183-7
92. Feicht CB, Johnson TS, Martin BJ, et al. Secondary amenorrhea in athletes. Lancet 1978; 11 (800): 1145-6
93. Barrow GW, Saha S. Menstrual irregularity and stress fractures in collegiate female distance runners. Am J Sports Med 1988; 16: 209-16
94. Loucks AB, Horvath SM. Athletic amenorrhea: a review. Med Sci Sports Exerc 1985; 17 (1): 56-72
95. Otis CL. Exercise associated amenorrhea. Clin Sports Med 1992; 11 (2): 351-62
96. Shangold M, Rebar RW, Wentz AC, et al. Evaluation and management of menstrual dysfunction in athletes. JAMA 1990; 263 (12): 1665-9
97. Sundgot-Borgen J. Prevalence of eating disorders in elite female athletes. Int J Sport Nutr 1993; 3: 29-40
98. Cann CE, Martin MC, Genaut HK, et al. Decreased spinal mineral content in amenorrheic women. JAMA 1984; 251 (5): 626-9
99. Drinkwuter BL, Bruemmer B, Chestnut III CH. Menstrual history as a determinant of current hone density in young athletes. JAMA 1940; 263 (4): 545-8
100. Lloyd T, Trientafyllou SJ, Baker ER, et al. Women athletes with menstrual irregularity have increased musculoskeletal injuries. Med Sci Sports Exerc 1986; 18 (4): 374-9
101. Warren MP, Brooks-Gunn J, Hamilton WG. Scoliosis and fractures in young ballet dancers: relation to delayed menarche and secondary amenorrhea. N Engl J Med 1986; 314: 1348-53
102. Brownell KD, Rodin J, Wilmore JH. Weight regulation practices in athletes: analysis of metabolic and health effects. Med Sci Sports Exerc 1987; 19: 546-56
103. Drinkwater BL, Nilson K, Ou S, et al. Bone mineral density after resumption of menses in amenorrheic athletes. JAMA 1986; 256: 380-2
104. Emans SJ, Grace E, Hoffer FA, et al. Estrogen deficiency in adolescents and young adults: impact on hone mineral content and effects of estrogen replacement therapy. Obstet Gynecol 1990; 76: 585-92
105. Prior JC, Vigna YM, Schecter MT, et al. Spinal bone loss and ovulatory disturbances. N Engl J Med 1990; 323: 1221-7
106. Myburgh KH, Hutchins J, Fataar AB, et al. Low hone density is an etiologic factor tor stress fractures in athletes. Ann Intern Med 1990; 113: 754-9
107. Marcus R, Cann C, Madvig P, et al. Menstrual function and hone mass in elite women distance runners: endocrine metabolic features. Ann Intern Med 1985; 102: 158-63
108. Robinson T, Snow-Harter C, Gillis D, et al. Bone mineral density and menstrual cycle status in competitive female runners and gymnasts. Med Sci Sports Exerc 1993; 25 Suppl. 5: S49
109. Cunn CE, Cavanaugh DJ, Schnurpfiel, et al. Menstrual history is the primary determinant of trabecular bone density in women runners. Med Sci Sports Exerc 1988; 20 Suppl. 2: S59