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Stress Fractures

Stress fractures tend to occur a lot more in women, especially now that women are becoming more athletically active, the level of intensity of their activity is increased, their bone size tends to be a little bit less than men, itís related to hormonal variances and dietary habits. Be concerned about foot wear, excessive amount or pronation of the foot or rotation of the hip, tibia vara which is roundedness of the tibia and especially running surfaces, or if they are using old shoes that do not have a lot of cushion.

Stress fractures, commonly seen mainly in the tibia. The tibia takes most of the load of the lower extremity, as 50% of the stress fractures happen in the tibias, fibulas are relatively rare. Runners are more common people that get this, and itís more commonly found in women. Here is a healing phase of a stress fracture, sometimes on radiographs you just notice a little bump in the tibia, but if you follow them over time, there is a healing phase that eventually eradicates this problem that they have. It usually happens on the compression side, it is usually proximal or distal third of the tibia, posterior medial side. Tension side stress fractures are usually in the middle third. You can see compression stress fracture of the proximal tibia in this adolescent patient. Plain radiographs may be negative early, repeating them sometimes helps, transverse fractures can be unicortical or bicortical. Bone scan is very sensitive to pick this up, MRI has become very sensitive as well. Bone scans tend to be a little bit less expensive.

Diagnosis: They usually have pain with their activities or activities of daily living, they usually have localized tenderness, there is periosteal thickening, they have point specific tenderness and if you are friends with your physical therapist or if you have physical therapy in your office, if you take the ultrasound head and slowly turn up the frequency right over the top of the area where the patient is painful, it will tell you whether it is truly a stress fracture, because that will hurt them. Bone scan shows the localized increased uptake related to the stress fracture.

Treatment: Compression side stress fractures heal pretty well. You can treat them symptomatically with nonweight bearing, sometimes a cast is necessary, the high risk and nonunion types can require surgical intervention, specifically as an orthopaedist, and that gets them back to their activities faster. Fibula, we usually can treat these without surgery, rest, splinting.

Overuse injuries can occur in any of the soft tissues, or even hard tissues of the body. About 30 to 50% of all sports practices are related to overuse injuries from repetitive trauma. The injury just overwhelms the soft tissue and failure occurs, so we see all types of athletes whether they are recreational or professional and it happens at all levels. Muscle and tendon injuries, itís age dependent. Adolescents, their weakest structure in the muscular tendinous extent tends to be at the growth plate. As we become young adults, itís the ligaments and the soft tissues, muscles and tendons. In older adults it tends to be the bone, and we see more fractures and bone injuries. Tears can happen within the substance of the tendon, where the tendon attaches to the bone, where the ligaments attach to the bone, or at the muscular tendinous junction. Most common mechanism of injury is excessive amount of stretch. It is usually failure of the musculotendinous junction or the muscle tendon units, it can be an intrasubstance degeneration. Normal physiology, there is a crimp or a wavy pattern to the tendon.