Intertrochanteric hip stress fracture in a male ultramarathon runner

Stress fractures are injuries frequently seen in high-performance athletes, especially runners. In the femur, the most commonly affected locations are the femoral neck, condylar area and proximal shaft. Intertrochanteric fractures are much more common in the elderly population, especially among those with osteoporosis, but they can also be a result of high-energy repetitive mechanisms. We present a case of an intertrochanteric stress fracture in a young male runner. The diagnosis was suspected after persistent pain following his first marathon, and it was confirmed with an MRI. Operative fixation of the fracture was performed 22 days after the pain started, which allowed the patient to return to his activities, including 50 km marathon 4 months following the surgery.

Recurrence of Scaphoid Stress Fracture: A Case Report

Background Scaphoid stress fractures are rare and typically present in young, elite male athletes. Due to the infrequency in which these injuries are encountered, the optimum management is not established. Case Description We present the case of a 20-year-old male gymnast with bilateral stress fractures of the scaphoid waist. Following conservative treatment, clinical and radiological signs of union were seen bilaterally. Eight months after return to normal activities, a unilateral recurrence of the stress fracture occurred. This was successfully treated with internal fixation and bone grafting. Literature Review Scaphoid stress fractures are most frequently seen in gymnasts but also occur in participants of other sports involving repetitive loading of an extended wrist. This action conveys force predominantly through the waist of the scaphoid. Most case studies have reported high union rates, whether treated operatively or conservatively, and the patients returned to high-level sport with no further problems. Stress fracture recurrence has been reported in other bones such as the metatarsal and tibia but never before in the scaphoid. Our case is unusual in that the patient suffered ongoing problems due to a recurrence of the scaphoid stress fracture after returning to normal activities. Clinical Relevance Clinicians should be aware that scaphoid stress fracture recurrence can occur, counsel patients accordingly, and remain vigilant after apparent union. We would recommend early fixation to allow a quicker return to function and prevention of recurrence.

Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

Hallux rigidus: clinical examination, radiology, and classification

The severity of hallux rigidus depends on the degree of joint involvement, from local pain to stress fractures of other bones of the foot due to hyper-support. Radiology is mandatory to have an accurate diagnosis and gives us a parameter of joint injury. We use the Coughlin and Shurnas classification as the gold standard for treatment. Level of Evidence IV.

Knowledge Assessment of Stress Bone Fractures among Soldiers in Saudi Arabia

Background: Stress fractures are well perceived in military preparing and athletes. Aside from knowledge of the frequency of these fractures and their impact on the economy and lost training hours, there are just a few studies in Saudi Arabia that show the real incidence of these fractures. The precise incidence must be known in order to provide recommendations for future preventative initiatives. This study aims to assess the knowledge of stress fractures among Saudi soldiers. Methodology: An observational cross-sectional study was conducted in medical centers; these centers are located in Saudi Arabia on male and female patients of all ages who are in Saudi military society to assess the knowledge of stress fractures among Saudi military society. Data collection was done by questionnaire that distributed between Saudi soldiers. Data was entered and analyzed using (SPSS) program, version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Results: Of all 1178 studied participants, 51.5% aged between 20- 30 years old. 91.7% were males. 47.5% of all participants had never heard of stress fractures before, 26.2% heard about it when joined military and 17.4% heard about it before joining the military field. 20.8% of all participants had stress fractures before, 10.4% were diagnosed through x-rays and medical history with the doctor, 4.6% were diagnosed through medical history only, and 2.4% diagnosed themselves. 85.3% of all participants agreed that stress fractures occur due to repetitive loading on the bones, 76.6% agreed that predominance of stress fractures of the lower extremities, over fractures of the upper extremities, 67.6% reported that stress fractures can be treated with painkillers, physiotherapy and reduce the risk and 78.6% agreed that stress fractures can be prevented by wearing appropriate footwear. Conclusion: Participants and relatively good knowledge of stress fractures. Knowledge of stress fracture was significantly associated with years of experience of participants, military sector, and residence area in the kingdom.

Bilateral stress fracture of the femoral neck in association with simultaneously developing osteonecrosis of the femoral head: a case report

Background Femoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture. Case presentation A 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery. Conclusions Bilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient’s complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.