Saturday, October 11, 2008

Stress fractures

1. What is the most common location for a stress fracture in running sports?
2. What factors predispose to stress fractures?
3. What are the symptoms of stress fracture?
4. How is a stress fx diagnosed?
5. What is the treatment for stress fx?

Answers:
1. Tibia
2. Females with late menses, low body wt, poor nutrition, tobacco/alcohol use, low bone density, over-pronation (genu valgum), leg length discrepancy, lack of flexibility, abrupt increases in training intensity, running on hard surfaces or worn out shoes.
3. Pain at onset of activity that grows more severe, localized to fracture site. Night pain may occur. There is tenderness at fracture site, as well as possible swelling and redness.
4. Plain films should be done first, although the fx may not be seen for 2-3 wks after symptoms develop, appearing first as periosteal thickening, followed by cortical lucency. Bone scan is very sensitive but non-specific. MRI is now first line since it is sensitive and specific.
5. If there is pain with ambulation, pt should be NWB for 7-10 days. At least 1-2 wks of pain-free ambulation before returning to impact activity, which should be started cautiously and increased incrementally. Predisposing factors should be addressed.

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