Stress fractures: diagnosis and management in the primary care setting.

Abstract

Stress fractures or fatigue fractures are common overuse injuries that occur following repetitive bouts of mechanical loading to bones. They most often occur in the weight-bearing bones of the lower limbs. Their diagnosis can be challenging due to their insidious onset and requirement for imaging to confirm a diagnosis. The risk factors for such injuries include an increase in load, which can be from an increase in volume, intensity, or duration of exercise, abnormal biomechanical factors, and reduced bone mineral density. Their management can be relatively straightforward, but symptoms can persist for many months if load management is not adhered to. If missed, the clinical consequences can be substantial, particularly when involving the femoral neck. Stress fractures occur when bones undergo repetitive stress at a rate greater than their ability to remodel. The initial microtrauma can cause symptoms, such as a pain and swelling, without the presence of a fracture on X-rays. This phenomenon is known as a ‘stress reaction’ and cannot be detected on X-rays in the early stages. If the causative factor continues, this can cause the cortex of the bone to weaken, leading to crack initiation. If this crack propagates across the bone then a complete fracture can occur. Stress fractures should not be confused with insufficiency fractures, which occur when physiological abnormal bone fractures under normal load (that is, secondary to osteoporosis). The incidence of stress fractures in the general population is not clear and most research has studied their incidence in the athletic …