Stress fractures in athletes: review of 196 cases

Abstract

The purpose of this study was to investigate theassociation of stress fractures with age, sex, sport level,sporting activity, and skeletal site in athletes seen at oursports medicine clinic between September 1991 and May 2001.During these 10 years, 10 726 patients (6415 males, 3861females) visited our clinic because of sport-related injuries,and 196 patients [125 males (1.9%), 71 females (1.8%)]sustained stress fractures. The average age of the patients withstress fractures was 20.1 years (range 10–46 years); 84 patients(42.6%) were 15–19 years of age, and 68 (34.7%) were 20–24years of age. Altogether, 74 patients (37.8%) were active atthe high recreational level and 122 (62.2%) at the competitivelevel. The sites of the stress fractures varied from sport tosport. The ulnar olecranon was the most common stressfracture site among baseball athletes and the rib among therowing athletes. Classical ballet, aerobics, tennis, and volleyballathletes predominantly sustained stress fractures of thetibial shaft. Basketball athletes predominantly sustained stressfractures of the tibial shaft and medial malleolus and themetatarsal bone, whereas track and field and soccer athletespredominantly sustained stress fractures of the tibial shaftand pubic bone. Our results show that stress fractures areseen even in high-level adolescent athletes, with similarproportions for males and females, and that particular sportsare associated with specific sites for stress fractures.