Stress fractures: aetiology and management principles

Abstract

Stress fractures are common injuries that may present to general practice, emergency departments or orthopaedic clinics. An understanding of how bone remodels, which has evolved since Wolff's original theory almost 130 years ago, aids treatment of stress fractures. Further research into the forces bones can withstand and the mechanisms of failure have helped prevention of these injuries. The aetiology is believed to be multifactorial. Various risk factors contribute at varying levels in individuals with stress injuries. Stress fractures can occur in weight-bearing bones as well as non-weight-bearing bones and the injuries are often specific to certain activities. In order to diagnose and treat these injuries, it is important for the clinician to understand the changes occurring at a microscopic level and the many contributory risk factors. These risk factors can be elucidated by a focused history and examination and supplemented with blood tests and radiological investigations. This information can aid the clinician in staging the injury and allow tailored treatment. This increases the chance of optimal recovery.