Diagnosis and treatment of stress fractures

Abstract

Stress fracture diagnosis and treatment are clinical techniques that cannot be separated. The clinician has to make staged decisions in fields of uncertainty. Frequently, diagnosis is based on the patients’ response to treatment (partial rest). Under diagnosis can lead to devastating results in certain stress fractures, whereas overdiagnosis may prevent training for significant periods of time, crucial to trainees, whether athletes or military personnel. Recognition that bone scintigraphy is associated with significant doses of ionizing radiation, has led to more conservative use of this tool for suspected tibial stress fractures. The management of suspected metatarsal stress fractures is clinical, assisted by x-rays. Subjects with complaints and signs indicative of a femoral stress fracture cannot be permitted to continue training. Femoral stress fractures must be ruled out scintigraphically, due to the risk of displacement without significant warning pain. The protocols presented are those recommended by the Israel Defense Forces Medical Corps, following many years of trail and improvement.