“Fatigue” Fracture or “March” Fracture

Abstract

HomeRadiologyVol. 42, No. 4 PreviousNext “Fatigue” Fracture or “March” FracturePublished Online:Apr 1 1944https://doi.org/10.1148/42.4.397MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractMarch fracture, recognized for many years, has under wartime conditions become a subject of renewed interest. It has been found to occur not only in the metatarsals, as the earlier reports would suggest, but in other weight-bearing bones as well. Since 1938, cases have frequently been recorded as occurring in the tibia, fibula, and femur, and more rarely in the pelvis and spine. Most of the earlier writers contented themselves with the designation “march fracture,” or simply “march foot,” in reference to the occurrence of the condition chiefly among soldiers subject to long and unaccustomed marches. Recently certain writers have used instead the term “fatigue” or “stress” fracture.Hartley (1) in a recent contribution strongly recommends the name “fatigue fracture.” He believes the condition is analogous to the fatigue fracture occurring in metals subject to increasing stresses and quotes Henschen's observation that by spectroradiographic methods exhaustion fractures have been shown to occur in bone under prolonged stress without adequate rest periods. He reserves the term for those cases in which a partial or complete fracture can be shown radiographically in apparently normal bone or in which a submicroscopic or molecular fracture can be inferred from the presence of callus or the subsequent history. There must be no systemic disease present which could cause bone weakness, and there must be no history of violence.Hartley, like others, calls attention to the curiously low incidence of fatigue fracture in both America and Great Britain, where, until recently at least, only scattered examples have been recorded, in contrast to the large numbers of cases encountered in Finnish, Swedish, Norwegian, and German recruits.By some these fractures have been confused with the pseudo-fracture of Looser but, as Hartley points out, they are quite different and entirely unrelated. Pseudo-fractures occur in diseased bone; they often involve non-weight-bearing bones; they are multiple, produce only slight callus, and may remain static for months. Fatigue fractures, on the other hand, are found in weight-bearing bones, of normal texture; they are usually single and are characterized by abundant callus, even though the fracture itself may be barely perceptible. The type occurring in the foot usually involves the shaft of the second or third metatarsal, less often the fourth, and rarely the fifth.Krause (2) divides the syndrome into four stages. (1) During the first week or ten days following the onset of symptoms, the roentgenogram may show only a narrow fracture line or possibly none at all. (2) In from one to three weeks after onset, a spindle-shaped callus formation is seen about the affected area and a fracture line is often visible. (3) Later, after immobilization, the callus is more sharply circumscribed and denser. The fracture line may still be visible. (4) The end-result is a slightly thickened cortex.Article HistoryPublished in print: Apr 1944 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 42, No. 4 Metrics Altmetric Score PDF download