Lower extremity stress fractures in pediatric and adolescent athletes

To familiarize primary care pediatricians with basic detection and treatment strategies of lower extremity stress fractures, while highlighting new research related to improving diagnosis and management approaches for pediatric and adolescent athletes.

Young age appears to be a risk factor for the development of stress fracture, but this difference may be secondary to differences in activity levels, for which most studies have not controlled. While use of radiographs and bone scan may be important to rule out other entities, MRI has emerged as the gold standard for definitive diagnosis of stress fractures. Since abnormal lower extremity biomechanics can have an etiological role in stress fracture, gait re-training may be an important feature of treatment of some patients. In addition, athletes with open physes appear to be predisposed to different sites and mechanisms of stress fractures than their skeletally mature counterparts, and may have poorer outcomes than previously reported in tibial shaft fractures.

As participation in competitive youth sports continues to increase, prospective studies are needed to enhance our understanding of epidemiological factors and optimal treatment strategies for pediatric and adolescent athletes.