Stress Fractures

Abstract

Stress fractures (SFs), or fatigue fractures, are common overuse injuries of bone often suffered by elite and recreational athletes. They may occur anywhere in the body since all bones, but especially those of the lower limbs, are involved in most sports-related activities. Extrinsic and intrinsic factors influence the probability of SF development, some of these factors, such as physical conditioning, are well known, but others are still a matter of debate, such as anatomical conformation, gender, nutrition and equipment. The literature consists mostly of case series, with only a few analyses providing generally applicable evidence concerning risks and treatment. Pain is related to the particular activity. The clinical diagnosis of SFs is not always apparent from the patient’s history and physical examination, such that imaging (MRI, bone scan and CT scan) is crucial. In most patients, non-surgical treatment - consisting of rest and NSAIDs followed by a gradual return to sports activity once clinical symptoms are no longer present and there is radiographic evidence of recovery of bone fracture — is successful after 12 weeks. The timing of surgical treatment is not yet well established and depends on the SF site, symptoms duration, and activity level. Surgeons specializing in sports medicine should strive to recognize SFs as early as possible to achieve the best results for these patients and to reduce inactivity for elite and recreational athletes. Further studies are needed to prevent this common overuse injury and to establish a treatment algorithm aimed at allowing the athlete to return to his or her activity as quickly as possible and at reducing the risk of refracture.