Stress fracture

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

A stress fracture is one type of incomplete fracture in bones. It is caused by “unusual or repeated stress”^[1] This is in contrast to other types of fractures, which are usually characterized by a solitary, severe impact.

It could be described as a very small sliver or crack in the bone; this is why it is sometimes dubbed “hairline fracture”. It typically occurs in weight-bearing bones, such as the tibia (bone of the lower leg) and metatarsals (bones of the foot).

It is a common sports injury, and more than half of the cases are associated with athletics.^[2]

Stress fractures usually have a narrow list of symptoms. It could present as a generalized area of pain, tenderness, and pain with weight-bearing. Usually when running, a stress fracture has severe pain in the beginning of the run, moderate pain in the middle of the run, and severe pain at the end and after the run.

With severe stress fractures, surgery may be needed for proper healing. The procedure may involve pinning the fracture site, and rehabilitation can take up to a half year.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Bones are constantly attempting to remodel and repair themselves, especially during a sport where extraordinary stress is applied to the bone. Over time, if enough stress is placed on the bone that it exhausts the capacity of the bone to remodel, a weakened site — a stress fracture — on the bone may appear. The fracture does not appear suddenly. It occurs from repeated traumas, none of which is sufficient to cause a sudden break, but which, when added together, overwhelm the osteoblasts that remodel the bone.

Stress fractures commonly occur in sedentary people who suddenly undertake a burst of exercise (whose bones are not used to the task). They may also occur in Olympic-class athletes who do extraordinary quantities of high-impact exercise, or in soldiers who march long distances.

Muscle fatigue can also play a role in the occurrence of stress fractures. For every mile a runner runs, more than 110 tons of force must be absorbed by the legs. Bones are not made to stand that much energy on their own and the muscles act as shock absorbers for the excess force. But, as muscles become tired and stop absorbing most of the shock, the bones experience greater amounts of stress. Finally, when muscles (usually in the lower leg) become so fatigued that they stop absorbing any shock, all forces are transferred to the bones.

Previous stress fractures have been identified as a risk factor.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Dr. Johnathan C Reeser states that, in the US, the annual incidence of stress fractures range from 5% to 30%, depending on the sport and other risk factors.

Stress fractures occur less frequently in those of black African descent than in Caucasians, due to a higher BMD (bone mineral density) in the former.

Women and highly active individuals are also at a higher risk. The incidence probably also increases with age due to age-related reductions in BMD, but children may also be at risk because their bones have yet to reach full density and strength. The female athlete triad also can put women at risk, as disordered eating and osteoporosis can cause the bones to be severely weakened.

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