scholarly journals Swimmers Are At Risk For Stress Fractures? A Systematic Review

2018 ◽  
Vol 6 (3) ◽  
pp. 25 ◽  
Author(s):  
Angelo V. Vasiliadis ◽  
Vasileios Lampridis ◽  
Dimitrios Georgiannos ◽  
Ilias Bisbinas
Keyword(s):  
Systematic Review ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Sport Activity ◽  
Stress Fractures ◽  
Extrinsic Factors ◽  
Rare Type ◽  
Stress Injury ◽  
Competitive Swimming ◽  
Competitive Swimmers

Background: Stress fractures occur most commonly in the weight-bearing bones of the lower extremities. Swimming, a non-weight-bearing activity, is a potential activity form which associated with stress fractures? Objective: This systematic review aims to provide an answer in the above question and also to identify the reported cases of stress fractures among swimmers. Method: A systematic and comprehensive search was conducted using PubMed and Research Gate databases before January 2017. The search process was completed using the keywords: “stress fracture”, “stress injury”, “fatigue fracture”, “swimming” and “swimmers”. Results: There have been only 10 studies describing stress fractures in swimmers. This rare type of injury is commonly diagnosed in the ribs of young competitive swimmers, irrespective of their preferred swimming stroke. The etiology is multifactorial and includes a combination of intrinsic and/or extrinsic factors. Conclusion: Although any sport activity can potential cause a stress fracture, competitive swimming seems to be relatively safe in this respect. Rib stress fractures appear as the most common stress fracture in competitive swimmers that clinicians should consider. A prompt diagnosis can shorten the time required for healing and decrease the risk of complication.

Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

2014 ◽  
Vol 7 (6) ◽  
pp. 515-521 ◽  
Author(s):  
Andrew R. Hsu ◽  
Simon Lee
Keyword(s):  
Computed Tomography ◽  
Stress Fracture ◽  
Guide Wire ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Functional Impairments ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

scholarly journals Bilateral Sacral Stress Fracture in Pregnancy without Osteoporosis - A Case Report and Literature Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A185-A185
Author(s):  
Yu-Fang Wu ◽  
Kenneth Lu ◽  
Christian M Girgis ◽  
Martina Preda ◽  
Veronica Angela Preda
Keyword(s):  
Stress Fracture ◽  
Imaging Modality ◽  
Case Reports ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Lumbar Radiculopathy ◽  
Mineral Density ◽  
Normal Bone Mineral Density ◽  
Sacral Stress Fracture ◽  
In Pregnancy

Abstract Purpose: Sacral stress fractures are rare complications which can arise during pregnancy or in the early postpartum period. We report a case and discuss the findings of a confirmed postpartum sacral stress fracture in a 39-year-old multiparous woman and review previous case reports in the literature of sacral stress fracture related to pregnancy. Methods: A review of the literature was conducted to examine the main characteristics of sacral stress fractures related to pregnancy. The Ovid/Medline, Embase and Google Scholar databases were searched with the inclusion criteria: human studies, English language, intrapartum, postpartum (within 6 months of parturition), sacrum and stress fracture. Our exclusion criteria included pubic fractures, vertebral fractures and non-English articles. The search terms included “stress fracture”, “postpartum”, “pregnancy”, “atraumatic” and the wildcard “sacr*”. 34 cases were found and summarised in Table 2. Results: 65% of patients had onset of symptoms postpartum. Most patients did not have risk factors for sacral stress fractures including macrosomia, excessive pregnancy weight gain, heparin exposure, rapid vaginal delivery or predisposition to accelerated osteoporosis. Lumbar radiculopathy can be a feature of sacral stress fracture and it is more common (17.6%) than reported in the literature (2%). MRI is the preferred imaging modality for its safety profile in pregnancy and high sensitivity. 70% of reported normal bone mineral density (BMD). The mainstay treatment for sacral stress fractures includes relative bedrest, analgesia and modified weight bearing exercises. Most patients have favourable outcome with complete symptom resolution. Conclusion: Sacral stress fractures in the absence of osteoporosis are rare complications of pregnancy that can present with lumbar radiculopathy. Conservative management often produces good clinical outcomes.

scholarly journals Prospective Evaluation of Vitamin D Levels and Stress Injury in Collegiate Female Long-Distance Runners

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Elizabeth L. McDonald ◽  
Kathleen Jarrell ◽  
Steven M. Raikin ◽  
Kristen Nicholson ◽  
Daniel Fuchs ◽  
...  
Keyword(s):  
Vitamin D ◽  
Stress Fracture ◽  
Serum Levels ◽  
Vitamin D Insufficiency ◽  
Stress Fractures ◽  
Distance Runners ◽  
Long Distance ◽  
Stress Injury ◽  
Vitamin D Levels ◽  
The Mean

Category: Lesser Toes, Midfoot/Forefoot, Sports Introduction/Purpose: The incidence of stress injury in female runners is reported in up to 21% of competitive runners, with female runners at higher risk for stress injury than men. Bone metabolism is closely linked with vitamin D, which may play a role in the high prevalence of stress fractures in female runners. Although runners who train outdoors in the southeastern US have adequate vitamin D levels, no study to date has evaluated runners in northeastern US. The aim of the study was to prospectively evaluate the relationship between 25-OH vitamin D serum levels and the incidence of stress injury in a cohort of collegiate competitive long-distance runners. Methods: 101 female collegiate runners from 7 Northeastern US colleges competing in varsity cross country were enrolled. Surveys were collected from all the study participants at the start of the fall cross country season reviewing demographics, weekly mileage, and medical history, including previous stress fracture incidence. Additionally, baseline (“summer”) serum 25-hydroxy vitamin D levels were obtained. Subjects insufficient in vitamin D (<30ng/mL) were supplemented with cholecalciferol (D3) 50,000 units weekly for 8 weeks and 2,000 units daily for an additional 1 month. In subjects with vitamin D insufficiency, repeat labs were performed at 3 months and repeat surveys distributed. To account for variation in season and geographical location, all subjects underwent repeat vitamin D labs at 6 months (”winter”). Fisher’s exact test was used to determine whether vitamin D levels were correlated with incidence of stress fracture. Results: 91/101 (90%) subjects with mean BMI of 20.5 and average age of 20 years completed all study requirements. The mean summer and winter vitamin D serum levels were 64.0 ng/mL (SD 16.6; range 28.9-112.9) and 45.0 ng/mL (SD 13.8; range 20.1- 90.6), respectively. One subject (1%) in the summer and 9 subjects (10%) in the winter were supplemented for vitamin D insufficiency. 7/10 (70%) insufficient subjects and 28/81 (35%) vitamin D sufficient subjects reported a stress fracture during the study period. Patients that had an insufficient vitamin D result were significantly more likely to have a stress fracture during the study period (p=0.041; Table 1). The mean change in vitamin D level from summer to winter was -19.7 (SD 14.4; range -60.5- 60.7). Conclusion: The high rate of stress fractures in this cohort of collegiate female long-distance runners is greater than previously reported. Runners who are vitamin D insufficient are at a higher risk to incur a stress fracture. The results of the study also highlight the considerable seasonal variance in vitamin D levels amongst female collegiate long-distance runners in the northeastern US. Further study is needed to determine whether vitamin D supplementation reduces the risk of stress fractures.

scholarly journals Not all ankle injuries are ankle sprains - Case of an isolated cuboid stress fracture

2018 ◽  
Author(s):  
Sidharth Unnithan ◽  
Joe Thomas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Left Ankle

A 22-year old lady, had a twisting injury to her left ankle followed by pain on prolonged weight bearing and walking. Magnetic resonance imaging with computed tomography correlation was done which showed an isolated cuboid stress fracture. Isolated cuboid stress fractures are very rare and are usually misdiagnosed as ankle sprains.

Ulnar stress reaction in an axillary crutch user

2020 ◽  
Vol 13 (11) ◽  
pp. e236219
Author(s):  
Ranita Harpreet Kaur Manocha ◽  
Jenelle Weidner
Keyword(s):  
Vitamin D ◽  
Weight Bearing ◽  
Vitamin D Supplementation ◽  
Stress Fractures ◽  
Stress Reaction ◽  
Stress Injury ◽  
First Case ◽  
Upper Extremity Injury ◽  
Forearm Pain

Ulnar stress fractures have been reported in athletes performing repetitive, high-impact activities, such as baseball pitchers and gymnasts. Crutch-assisted walking also results in cyclical forearm loading. We report the first case of ulnar stress reaction due to axillary crutch use. A 23-year-old right-handed woman experienced right forearm pain and imaging confirmed a right ulnar stress injury. The patient was also found to have mild hypercortisolism, low bone mass and vitamin D deficiency. Crutches were discontinued and physical therapy to normalise weight bearing through the left leg was prescribed. The patient’s right forearm symptoms resolved and she was started on oral vitamin D supplementation. Axillary crutch use may result in ulnar stress injury, particularly in vulnerable populations. The addition of an upper extremity injury to someone with impaired mobility may compound disability. As such, clinicians should be aware of the clinical presentation of ulnar stress fractures in the long-term axillary crutch user.

Stress fracture in a ceratopsian phalanx

1988 ◽  
Vol 62 (2) ◽  
pp. 302-303 ◽  
Author(s):  
Bruce M. Rothschild
Keyword(s):  
Fatigue Fracture ◽  
Stress Fracture ◽  
Fracture Stress ◽  
Stress Fractures ◽  
Periosteal Reaction ◽  
Stress Fatigue

A prominent anterior bulge on a ceratopsian dinosaur phalanx was examined for evidence of infection or stress (fatigue) fracture. The presence of a knife-slice type radiolucency, associated with periosteal reaction, was pathognomonic (diagnostic) for a stress fracture. Stress fractures have previously been recognized only in humans, racing greyhounds, and horses.

scholarly journals Preliminary image findings of lower limb stress fractures to aid ultrasonographic diagnoses: A systematic review and narrative synthesis

Ultrasound ◽  
2021 ◽  
pp. 1742271X2199552
Author(s):  
Madeleine Schaper ◽  
James Harcus
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
Injury Severity ◽  
Callus Formation ◽  
Plain Film ◽  
Stress Fractures ◽  
Doppler Imaging ◽  
Narrative Synthesis ◽  
Plain Film Radiography ◽  
Bony Callus

Introduction This systematic review investigates which image appearances are most common when diagnosing lower limb stress fractures using ultrasound imaging, with the aim of outlining an image critique guideline for operators to support confident diagnoses. Method A comprehensive literature search of medical databases and handsearching was undertaken to identify relevant studies. All studies were critically examined for quality using the CASP critical appraisal tool. Results from eight studies were combined and interpreted using a narrative synthesis. Findings A clear outline of common stress fracture appearances using ultrasound were identified in a combined total of 119 participants. Each finding was ranked according to its popularity. Periosteal thickening (78/119) and cortical disruption/irregularity (83/119) were noted in all eight studies. Hypervascularity of the periosteum visualised by colour Doppler imaging (66/119) was reported in six of the eight studies. Soft tissue hypervascularity (13/119), bony callus formation (5/119) and cortical break (22/119) were seen in three studies. Conclusions Based on the findings, we offer a guideline of the most significant preliminary image findings to be utilised by operators when examining athletes suspected of having lower limb stress fractures. The results show a gap in research for evaluating changes in appearance depending on the injury severity. Further research into distinguishing stress fractures from pathological involvement may in future reduce reliance on plain film radiography.

scholarly journals Musculoskeletal biomechanics in sit-to-stand and stand-to-sit activities with stroke subjects: a systematic review

2010 ◽  
Vol 23 (1) ◽  
pp. 35-52 ◽  
Author(s):  
Christina Danielli Coelho de Morais Faria ◽  
Viviane Amaral Saliba ◽  
Luci Fuscaldi Teixeira-Salmela
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Weight Bearing ◽  
Experimental Studies ◽  
Quality Parameters ◽  
Lower Limbs ◽  
Extensive Literature ◽  
Manual Search ◽  
Sit To Stand ◽  
Extensive Literature Search

INTRODUCTION: Sit-to-stand and stand-to-sit are two of the most mechanically demanding activities undertaken in daily life and which are usually impaired in stroke subjects. OBJECTIVES: To determine the distinguishing characteristics in musculoskeletal biomechanical outcomes of the sit-to-stand and stand-to-sit activities with stroke subjects, with an emphasis on the clinical management of stroke disabilities, in a systematic review. MATERIAL AND METHODS: An extensive literature search was performed with the MEDLINE, CINAHL, EMBASE, PEDro, LILACS, and SciELO databases, followed by a manual search, to select studies on musculoskeletal biomechanical outcomes in both activities with stroke subjects, without language restrictions, and published until December/2007. RESULTS: Out of the 432 studies, only 11 reported biomechanical outcomes of both activities and none reached the total score on the selected quality parameters. The majority of the experimental studies which compared groups did not achieve acceptable scores on their methodological quality (PEDRo). The investigated conditions and interventions were also restricted. Only one study compared biomechanical outcomes between the activities, but only evaluated the time spent to perform them. Few musculoskeletal biomechanical outcomes have been investigated, being weight bearing on the lower limbs and duration of the activities the most investigated. CONCLUSION: There is little information regarding musculoskeletal biomechanical outcomes during these activities with stroke subjects and no definite conclusions can be drawn regarding the particularities of these outcomes on their performance with stroke survivors.

A descriptive study of stress fractures in competitive event horses in the UK

2004 ◽  
Vol 1 (4) ◽  
pp. 233-238
Author(s):  
Emma Hayton ◽  
Jennifer C Sneddon
Keyword(s):  
Stress Fracture ◽  
Descriptive Study ◽  
Stress Fractures ◽  
Anatomical Location ◽  
True Prevalence ◽  
Fracture Prevalence ◽  
The Uk ◽  
The Impact ◽  
Larger Sample ◽  
Age Category

AbstractThe impact of stress fractures on competitive event horses in the UK is completely unknown. Ninety-one replies to 450 questionnaires sent to competitive event riders across the UK indicated that 11 horses, representing 12% of the responders, had a confirmed stress fracture. As data on the total number of horses owned or ridden by the riders were not available, the true prevalence of stress fractures in this sample of horses could not be directly assessed. Within the bounds of this study, competitive level of the rider had a significant effect on stress fracture prevalence (X2(0.05, df. 2) = 24.74, P<0.05), as did years of eventing experience (X2(0.05, df. 1) = 27.80, P<0.01). Training regime was also influential (X2(0.05,df. 1) = 26.30, PX20.01). There was a predominance of fractures in geldings (X2(0.05, df. 1) = 24.45, P<0.03); however, geldings constituted 82% of reported cases. Thoroughbred cross horses had a significantly lower incidence of stress fractures than Thoroughbreds (X2(0.05, df. 1) = 20.82, P<0.01) but constituted only 18% of the sample. Horses in the oldest age category (9–12 years) had 6% of all stress fractures (X2(0.05, df. 2) = 24.54, P<0.1). All fractures occurred on the foreleg at the knee or below, with no significant effect of anatomical location. Seventy-three per cent of horses were not competing when diagnosed (X2(0.05, df. 1) = 22.27, P<0.1). These data indicate that useful preliminary data were yielded by the questionnaire and that further research with a larger sample size is justified.

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