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Stress fractures in skeletally immature patients
R N Walker1, N E Green, K P Spindler
1Vanderbilt University Medical Center in Nashville, Tennessee, USA.
Insights
Pediatric stress fractures, common in young athletes, typically present as activity-related pain. Most cases heal effectively with conservative treatment, such as activity modification or immobilization.
Area of Science:
- Orthopedics
- Pediatric Sports Medicine
- Radiology
Background:
- Stress fractures are prevalent injuries in active individuals.
- Increased participation in organized sports among children necessitates understanding pediatric stress fractures.
- Differentiating stress fractures from infections or neoplasms is crucial in skeletally immature patients.
Purpose of the Study:
- To review the characteristics of stress fractures in skeletally immature patients.
- To identify common sites, presentations, and clinical courses of pediatric stress fractures.
- To evaluate the effectiveness of conservative management for these injuries.
Main Methods:
- Retrospective review of 34 stress fractures in 32 skeletally immature patients (June 1977 - May 1993).
- Data collected included age, fracture location, treatment, healing time, associated conditions, complications, radiographs, and clinical outcomes.
- Analysis focused on sports involvement, presenting complaints, and radiographic findings.
Main Results:
- 50% of patients participated in sports; pain with activity was the most common complaint.
- The tibia was the most frequent site (47%), followed by the fibula (21%) and femur (12%).
- All patients experienced symptom resolution and returned to normal activity, with most healing through activity modification or immobilization.
Conclusions:
- A thorough history, physical examination, and radiographic assessment aid in diagnosing pediatric stress fractures.
- Conservative management is effective for most stress fractures in skeletally immature individuals.
- Distinguishing stress fractures from other conditions like infection or neoplasm is achievable with appropriate evaluation and treatment.
Abstract:
Stress fractures are a common injury in an active population. As children become increasingly involved in organized sports, the recognition of stress fractures and differentiation from infections or neoplasms requires a knowledge of their most common sites, presentation, and clinical course. We retrospectively reviewed 34 stress fractures in 32 skeletally immature patients from June 1977 to May 1993. Age, fracture location, treatment, time to union or healing, associated conditions, complications, radiographs, and clinical outcome were recorded. Fifty percent of patients were involved in sports; the most common complaint was pain with activity. The most common site was the tibia (47%) followed by the fibula (21%) and femur (12%). All had resolution of symptoms and returned to normal activity. All but two healed with either activity modification or cast immobilization. The radiographic findings included early periosteal callus formation that rapidly consolidated to new bone on serial studies. A careful history, physical examination, and radiographs can help diagnose most common stress fractures in the skeletally immature individual and can differentiate stress fractures from infection or neoplasm with appropriate conservative treatment.