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An example of stress fracture of the coracoid process of the scapula in a trapshooter is presented. The value of the axillary view of tbe shoulder is emphasized.
Clay-shoveler's fracture is a fatigue fracture of a lower cervical or upper thoracic spinous process. This occupational injury occurs primarily in workers who shovel heavy loads for long periods of time. It was common and well known at the beginning of the XXth century, but has become relatively rare since the introduction of earth-moving machinery, and is now frequently overlooked. A review of clay-shoveler's fracture is presented. Emphasis is put on the legal aspects that can raise problems for rheumatologists, radiologists, occupational physicians and physicians performing expert evaluations of patients filing compensation claims.
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Stress fractures are common overuse injuries, ranging between 1.1% and 3.7% of all athletic injuries. Causes are many and usually involve repetitive submaximal stress. There is a wide research evidence showing that training errors cause stress fractures in as many as 22% to 75% of cases. Intrinsic factors such as hormonal imbalance may also contribute to the onset of stress fractures, especially in women. During medical examination, it is essential always to bear in mind the possibility of stress fracture. Clinical diagnosis is therefore the basic procedure, followed by other diagnostic methods in the following order: radiology, scintigraphy, and MRI. Most stress fractures are uncomplicated and can be managed through rest and restriction from precipitating activities for 4-6 weeks. A subset of stress fractures can present a high risk for progression to complete fracture, delayed union, or nonunion. Specific sites for this type of stress fracture are the femoral neck, the anterior cortex of the tibia, the tarsal navicular, the fifth metatarsal (Jones fracture), and the great toe sesamoids. Therefore, high-risk stress fractures require aggressive treatment, and in some cases even surgical intervention is appropriate.
Stress fractures are a common occurrence in athletes, and the incidence of stress fractures in female Division 1 collegiate athletes is double that of men. Hormonal influences on bone and bone morphology may influence the risk for fracture. A high level of suspicion and special imaging procedures allow for accurate diagnosis of these fractures. In stress fractures that are associated with the female athlete triad, addressing the three aspects of the triad--eating disorders, amenorrhea, and osteoporosis--are critical for successful treatment. Preparticipation screening for the presence of signs of the female athlete triad by monitoring weight, energy level, menstrual cycles, and bone mineral density may help to prevent the occurrence of stress fractures in this population.
Stress fractures may be fatigue or insufficiency related. Fatigue stress fractures result when healthy bones are exposed to intense and/or repetitive loads for which the bone is not prepared. Insufficiency stress fractures result from normal loads to bones weakened by genetic, metabolic, nutritional, or endocrine processes. Fracture usually begins as a small cortical infarction that progresses as stress increases or continues. Pain is the hallmark symptom of both types. When confronted with signs and symptoms consistent with stress fractures, providers must consider risk factors, comorbid conditions, and whether or not the mechanism of the injury is consistent with the clinical picture. Though the two types of stress fractures are treated differently, in both, the prognoses are dependent on early identification and intervention.
Stress fractures can be challenging to treat. It is important to educate the clinician in the pathophysiology, etiology, evaluation, and treatment of stress fractures with special emphasis on troublesome and upper extremity stress fractures, along with the pathophysiology of fatigue failure of bone and the etiology of clinically significant stress fractures. A classification system has been outlined to facilitate management of troublesome stress fractures.
Stress fractures are common overuse injuries attributed to the repetitive trauma associated with vigorous weightbearing activities. A high index of suspicion is necessary to diagnose stress fractures of the femur because the symptoms may be vague. The precipitating factors, whether related to training errors or medical conditions, should be thoroughly evaluated. Early diagnosis of distraction femoral neck stress fractures is critical to avoid serious complications. Femoral shaft stress fractures have excellent healing potential when diagnosed early and treated non-operatively. Stress fractures of the femoral condyles are uncommon, but should be included in the differential of knee pain.
Stress fractures are common injuries, particularly in endurance athletes. Stress fracture management should take into consideration the injury site (low risk versus high risk), the grade (extent of microdamage accumulation), and the individual's competitive situation. The authors briefly discuss the pathophysiology and diagnostic process of stress fractures and expand on the classification of stress fractures and its impact on return-to-play decision making based on the relative risk of the fracture.
Stress fractures can represent a diagnostic problem especially in their differentiation from bone tumours. 6 patients with 7 lesions were examined. MRI visualised the stress fractures and established the diagnosis of stress fracture vs. tumour in 6 cases. In the seventh, biopsy having been performed, a tumour was ruled out. MRI is more sensitive than radiography in the detection of stress fractures, showing the characteristic changes earlier. MRI, being a very sensitive method in the diagnosis of stress fractures and a reliable one in their differentiation from bone tumours, can be applied in cases of unusual clinical course and difficult radiological diagnosis prior to biopsy.
Stress fractures can occur in almost any bone in the body, with the lower extremity weightbearing bones, especially the tibia, tarsals, and metatarsals, being affected most frequently. Although the cause of these fractures is multifactoral, repetitive physical forces without adequate rest are the primary culprits. Stress fractures may be broadly classified as low-risk or high-risk injuries. Low-risk stress fractures, the topic of this review article, can be diagnosed through a thorough history, physical examination, and radiographs. Nuclear scintigraphy is occasionally necessary for confirmation, especially for fractures of the spine and pelvis. When diagnosed early and treated with restriction of activity, low-risk stress fractures have a favorable prognosis.
Stress fractures are common over-use injuries which include fatigue and insufficiency fractures. Athletes, soldiers and osteoporotic patients are some of the individuals at high risk for the development of this injury. Owing to the low sensitivity of plain radiography at the onset of symptoms the diagnosis of this entity may be easily overlooked. Occasionally, some of these fractures, such as tibial fracture in children and fractures in the clavicle and pelvic ring, can be misdiagnosed as tumoral or infectious processes; moreover, although most stress fractures are uncomplicated and can be managed by rest and restriction from precipitating activity, a subset of these fractures can present a high risk for progression to complete fracture or non-union problems. All of this indicates that the various types of stress fracture, owing to their different clinical characteristics and evolution, should be commented on in detail. In this chapter different types of stress fracture are described with special reference to their localization, clinical characteristics, evolution and treatment.
Stress fractures occur with strenuous activity and represent a unique and relatively rare traumatic entity. Their diagnosis is difficult and therapy accompanied with specific problems. The purpose of the presented study is to explain basic characteristics of stress fractures and to approximate possibility of diagnosis and treatment better. Out of 26 fractures, 22 (84.62%) were nondisplaced and managed by bed rest, non-weight bearing or plaster of Paris immobilization for eight to ten weeks. On the other hand, four primarily displaced fractures (15.38%) were successfully treated with rigid internal fixation. Four conservatively managed patients (18.18%), two with fractures of the tibia and two with fractures of the femoral neck, attained a secondary angulation and pseudoarthrosis of the fracture site and, for these reasons, recorded injuries demanded a compensatory surgery management. It is suggested that in case of suspectability of stress fractures it is beneficial to use, parallel to native radiographic study, the bone scan imaging techniques which in the earlier phase of the disease establishes the diagnosis. Treatment of the stress fractures should be, as a rule, conservative. Moreover, "fatigue" fractures of the tibia and femoral neck ask for more continuous observations and a serious access. If non weightbearing regiment and immobilization do not decrease the difficulties; and fracture patterns progress, or if fracture becomes displaced because of delayed diagnosis, open reduction and rigid internal fixation should be done without delay.
Stress fractures in children are uncommon. This report describes the findings of 8 cases in 6 children. One patient had 3 stress fractures: 2 consecutive midshaft stress fractures of the same tibia associated with one of the fibula. Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Serial radiographs and computed tomography scans are the key to the diagnosis, although bone scan and magnetic resonance imaging can be helpful. Biopsy is unnecessary and might even be misleading.
Stress fractures result from skeletal failure resulting from submaximal repetitive forces over time. Sacral stress fractures may represent an underdiagnosed cause of low back and buttock pain. They occur primarily in two populations, young active persons and elderly osteoporotic women, usually corresponding to fatigue and insufficiency-type fractures, respectively. The clinical presentation of these fractures is similar, but the medical and rehabilitation management of these patient populations differs and is tailored to the specific underlying etiology. In both types of fractures, appropriate conservative measures generally result in good functional outcomes. This paper provides an overview of the anatomical considerations, risk factors, clinical presentations, diagnostic imaging findings, appropriate laboratory studies, medical management, and rehabilitation management of patients with sacral stress fractures.
Stress fractures of the diaphysis of the femur are very rare, particularly bilateral ones. We describe here a woman patient with bilateral pseudoarthrosis of the femoral diaphysis which was the result of a stress fracture. The case is a rarity because the in question is of a dwarfism stature with great deformation of the lower extremities due to rickets. The patient has been closely examined for over 30 years. Our own explanation for the beginnings of stress fracture as well as for the pseudarthrosis development are given.
Stress fractures are a frequent cause of injury in competitive and recreational athletes. Although a number of epidemiologic studies have been conducted, the populations studied and data collection methods have varied. This article presents an overview of injury epidemiology and reviews the current body of literature regarding the occurrence of stress fractures in athletes. Given the heterogeneity of the populations studied and the variations in data collection, few broad conclusions can be drawn. There is a pressing need for large prospective studies to better establish the risks of stress fracture by sport, age, and gender.
Stress fractures can occur if normal bone is exposed to repeated abnormal stress (fatigue fractures) or if normal stress is placed on bones with compromised elastic resistance (insufficiency fractures). This article describes two patients without a history of excessive stressful activity or apparent metabolic bone disease who developed bilateral distal tibial stress fractures. Different etiologies, clinical presentation, differential diagnosis, and diagnostic imaging modalities of stress fractures are discussed.