Stress fractures

Area of Science:

• Sports Medicine
• Orthopedics
• Bone Health

Background:

• Stress fractures (SF) account for 10%-20% of sports medicine injuries.
• SFs arise from repetitive abnormal bone loading exceeding the body's adaptive capacity, causing microdamage.
• Etiology is multifactorial, involving intrinsic and extrinsic risk factors.

Purpose of the Study:

• To review the diagnosis, risk factors, and management of stress fractures.
• To emphasize the importance of early detection and appropriate classification for treatment and return to sport.
• To highlight the role of Relative Energy Deficiency in Sport (RED-S) and menstrual status in female athletes.

Main Methods:

• Literature review focusing on stress fracture etiology, diagnosis, and treatment.
• Discussion of diagnostic tools including history, physical examination, laboratory tests, and imaging (MRI as gold standard).
• Analysis of risk factors such as RED-S and menstrual irregularities in women.

Main Results:

• Localized pain, swelling, and tenderness worsening with activity are common presentations.
• Classification of SFs by type, location, grading, and risk level guides management.
• Low-risk SFs are typically managed conservatively, with calcium and vitamin D supplementation suggested.

Conclusions:

• Early detection and accurate classification of stress fractures are vital for optimal outcomes.
• Conservative management is standard for low-risk fractures, but other treatments are not well-established.
• Further understanding of SF pathophysiology and bone-active therapeutics is needed for improved treatment strategies.