Les fractures de fatigue du col fémoral et du bassin chez le sportif

Abstract

Fatigue fractures are the result of repeated mechanical stresses above the resistance threshold on a healthy bone. Repeated mechanical stress may cause fatigue fracture in the dendritic processes of osteocytes leading to an activation of bone remodeling where osteoclastic destruction is greater than osteoblastic formation. Fatigue fractures generally occur in young, healthy, active subjects and represent the most frequent pathology of sport and occur mainly in the lower limbs. The activities most at risk are: marathon, cross-country running, basketball, gymnastics, and ballet dancing and among army recruits. Femoral neck and pelvis are not the most common sites of fatigue fractures. The risk factors are: abrupt increment in the intensity of training, female sex, low body mass index, estrogen deficiency, predisposing anatomical factors and footwear errors. The diagnosis is suspected on mechanical pain of increasing intensity at the time of loading in a subject at risk and requires confirmation by radiological investigations. While plain radiographs must be performed as a first-line procedure, MRI has now become the gold-standard second-line imaging investigation, even providing for professional athletes prognostic factors to predict a return to sports activity. Except for fractures of the femoral neck in areas of tension, which are at high risk of complications and require surgical management, treatment is mainly based on sports rest and the normalization, where appropriate, of vitamin, calcium and energy intake.