Overuse Bone Trauma and Stress Fractures

Abstract

Stress-related bone injuries are common in athletes who are exposed to increased frequency, duration and intensity of activity. They are most common in the weight-bearing bones of the lower extremities, especially the posteromedial tibia. Under physiological circumstances, increasing the load on a bone will increase its strength through bone remodeling. When remodeling is unable to keep up with repetitive loading, a stress fracture will occur. The distinction between high-risk and low-risk stress fractures has prognostic and therapeutic consequences in athletes. Several extrinsic and intrinsic risk factors have been recognized. Overall, women are more sensitive to stress fractures than men. Conventional radiographs, despite having a low sensitivity, are used as a first-line test. Magnetic resonance imaging is the most sensitive and specific imaging modality for stress fractures. Computed tomography can be used as a problem solver in case of inconclusive MRI, and to better display fracture lines in a few specific locations.