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Published on: April 11, 2018
Incidence, Anatomic Distribution, and Return to Training After Stress Fractures in Okinawan Athletes
Fuminari Uehara1, Kotaro Higa1, Hiroki Yabiku1
1Department of Orthopedic Surgery, University of the Ryukyus, Ginowan city, Okinawa, Japan.
Background:
Stress fractures are common in young athletes and a major cause of time lost from training. While epidemiological data exist from Western countries, reports from Asian regions, particularly in subtropical settings, are limited, as year-round training may influence injury risk.
Purpose:
To assess stress fracture characteristics among adolescent and recreational athletes in Okinawa.
Study Design:
Descriptive epidemiology study.
Methods:
A retrospective review of medical records from orthopaedic clinics and sports medicine centers across Okinawa Prefecture, Japan, between 2018 and 2019 was conducted. Athletes aged <50 years who were diagnosed with imaging-confirmed stress fractures were included. Data on age, sex, sport, fracture site, and return to training (RTT) (defined as symptom-free resumption of sport-specific practice) were collected.
Results:
A total of 309 stress fractures were identified in 303 athletes (mean age, 15.6 ± 5.9 years; 47% women). The tibia (31%), metatarsals (28%), and tarsal bones (18%) were the most frequently affected sites. Soccer (21%), basketball (21%), and track and field (14%) accounted for the majority of cases. The median RTT time was 7 weeks (interquartile range [IQR], 4-8 weeks). High-risk fracture sites, such as the fifth metatarsal bone and patella, required significantly longer recovery (median, 8 weeks [IQR 4-12 weeks]; P < 0.01).
Conclusion:
This is the first epidemiological study on stress fractures in a subtropical region of Japan. The findings highlight sport- and site-specific patterns and demonstrate that high-risk anatomic sites require prolonged recovery before a safe return. These results provide important evidence for the development of region-specific prevention and rehabilitation strategies for adolescents and recreational athletes.
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