Original articleStress Fractures in the Young Athlete: A Pictorial Review
Section snippets
Pathogenesis
There are 2 main types of stress fractures—fatigue stress fractures and insufficiency stress fractures. Fatigue fractures occur in normal healthy bone because of abnormal muscular stress of unusual forces. These injuries are more common in young athletes when there is a continuous repetitive strain on the bones. There is often a history of a rapid increase in the training program. Females are slightly more often affected than males.
Insufficiency fractures occur in unhealthy bone that is mineral
Conventional Radiographs
If the classic findings of periosteal reaction, endosteal thickening, and/or a radiolucent cortical line (indicating the fracture site) are present then a confident diagnosis can be made. However, stress fractures may have similar features to pathologic fractures or chronic osteomyelitis on conventional radiographs, and other imaging modalities are often required to distinguish between these entities.10
In cancellous bone, stress fractures can be very hard to identify on conventional
Differential Diagnoses and Pitfalls
The main differential diagnoses for stress fractures that should be considered are as follows: infection, neoplastic processes, tendinitis, periostitis, osteoid osteoma, stain, sprain, compartment syndrome, and intermittent claudication.
Conventional radiographic changes of cortical thickening or periosteal reaction in long bones of children and adolescents are often nonspecific. Stress fractures are often misdiagnosed for infection or neoplastic processes.5 Obtaining a meticulous clinical
Lower Limb
Ninety-five percent of pediatric stress fractures occur in the lower limb with an equal male-to-female ratio.4, 33, 34 The age of the patient and type of activity plays an important role in the distribution of fractures. Femoral and tarsal fractures occur in older athletes, whereas in the pediatric population tibial and fibular fractures are more common. Endurance athletes are more likely to sustain metatarsal fractures, whereas those who are involved in sports with jumping and sudden stopping
Outcome
Most stress fractures tend to be treated conservatively with rest and nonweight-bearing with good result. Only a few studies have investigated outcome in the pediatric athlete.2, 3 Niemeyer et al found that around two-thirds of stress fractures were symptom free, when managed conservatively, 3 months after diagnosis.2 In the remainder of cases, there were persistent symptoms at 1 year. There were no pseudoarthroses. Delay in the diagnosis or poor patient compliance can lead to delayed healing
Conclusions
The presentation of stress fractures in the young athlete is variable, which may lead to confusion with other conditions such as tumors and osteomyelitis. More than 90% of the stress fractures occur in the lower limb, particularly the tibia and metatarsals. A suggested imaging algorithm for a suspected stress fracture is presented in Fig 26. Conventional radiographs, although insensitive, remain the initial imaging modality in most circumstances. If the diagnosis is clear, no further imaging is
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