A TEN YEAR REVIEW OF STRESS FRACTURES

Abstract

This study reviews a ten year history of division one college athletes in a single institution who were seen by the athletic training dept. staff with symptoms consistent with lower extremity stress fracture. This institution sponsors 11 womens' sports and 11 mens' sports. Over the ten-year period of this review approximately 6,000 athletes participated in these sports. A confirmatory diagnosis of stress fractures in this population was made by x-ray, MRI, and/or bone scan. 83 athletes presented with symptoms clinically suspicious for a lower extremity stress fracture. 6 of these athletes had negative MRI's and were excluded from this project. Stress fractures were diagnosed in 32 males and 45 females. The stress fractures were grouped into the following locations: Femur, Tibia, Fibula, Foot (Mid-hind) and Forefoot (metatarsal and phalanx). A review of the location of the stress fractures by sport revealed the following profiles. All teams with the exception of football and wrestling followed the same treatment protocol for diagnosis and return to activity and are the basis for our subsequent analyses. These 74 remaining stress fractures diagnosed by MRI were graded on a scale of 1–4. Time to return to limited and full activity were obtained from a retrospective review of training room charts. We also evaluated the year of the stress fracture diagnosis in comparison to the presence of a new head coach. Time to full return to sport was dependent on stress fracture grade. Mean time to return to sport for Grade I stress fractures was 2.91(2.81, 0–11) weeks, Grade II was 5.25 (3.88, 0–10) weeks, Grade III was 10.08 (3.25, 3–16) weeks, Grade IV was 12.10 (7.16, 5–24). 28% of athletes in the first year of a new tenure of a coach had stress fractures. When Grade I and II stress fractures were combined and then compared to Grade III and IV stress fractures there was a significant difference in the time to return to full activity (p = .000). Chi-square showed a significant relationship between the presence of a new coach and the occurrence of stress fractures χ = .022. This descriptive project provides us with a profile by sport of location of stress fracture. Using MRI to define the grade of stress fracture can be useful in prediction of time to return to limited and full sport participation.TABLE: Stress Fracture Location by Sport