Stress fractures: definition, diagnosis and treatment

Astur, Diego Costa; Zanatta, Fernando; Arliani, Gustavo Gonçalves; Moraes, Eduardo Ramalho; Pochini, Alberto de Castro; Ejnisman, Benno

doi:10.1016/j.rboe.2015.12.008

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Update Article • Rev. bras. ortop. 51 (1) • jan-feb 2016 • https://doi.org/10.1016/j.rboe.2015.12.008 copy

Stress fractures: definition, diagnosis and treatment^{^☆} ☆ Work performed at the Sports Traumatology Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. They occur as the result of repeatedly making the same movement in a specific region, which can lead to fatigue and imbalance between osteoblast and osteoclast activity, thus favoring bone breakage. In addition, when a particular region of the body is used in the wrong way, a stress fracture can occur even without the occurrence of an excessive number of functional cycles. The objective of this study was to review the most relevant literature of recent years in order to add key information regarding this pathological condition, as an updating article on this topic.

Keywords:
Stress fracture/epidemiology; Stress fracture/physiopathology; Stress fracture/diagnosis; Stress fracture/classification; Stress fracture/treatment

Stages/grades of Arendt and Griffiths for bone injuries due to stress, based on magnetic resonance imaging (MRI) findings
Grade of injury due to stress	MRI findings	Duration of resting period needed for cure (weeks)
1	STIR-positive	3
2	STIR and T2-weighted positive images	3–6
3	T1 and T2-positive without definition of cortical rupture	12–16
4	T1 and T2-positive with definition of cortical rupture and visible fracture line	16

Low-risk stress fractures
Upper limbs	Clavicle, scapula, humerus, olecranon, ulna, radius, scaphoid, metacarpals
Lower limbs	Femoral diaphysis, tibial diaphysis, fibula, calcaneus, metatarsal diaphyses
Thorax	Ribs
Dorsal spine	Pars interarticularis, sacrum
Pelvis	Ischiopubic rami

High-risk stress fractures
Femoral neck (superolateral)
Anterior cortical bone of the tibia
Medial malleolus
Navicular bone
Base of the second metatarsal
Talus
Patella
Sesamoids (hallux)
Fifth metatarsal

MRI findings according to Fredericson
Lesion stage
0	Normal
1	Periosteal edema
2	Periosteal and medullary edema on T2-weighted images
3	Periosteal and medullary edema on T1 and T2-weighted images
4	Periosteal and medullary edema with visible fracture line

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:mcastur@yahoo.com (D.C. Astur).

Brasil

Brasil

Stress fractures: definition, diagnosis and treatment☆ ☆ Work performed at the Sports Traumatology Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

ABSTRACT

Stress fractures: definition, diagnosis and treatment^{^☆} ☆ Work performed at the Sports Traumatology Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.