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STRESS FRACTURE
Wenas Arjanggi Hartas (07700239)Sisar Priya Nur a!an (07700023)
Tut"r #
$r% &a'su! Pan$ei!a S*%+T
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+,er,ie-
T.e stress ra1ture is a 1"!!"n ",eruseinjury seen in at.etes an$ !iitaryre1ruits% 24
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5e6niti"n
A stress ra1ture is 1ause$ y re*etiti,e an$su!a8i!a "a$ing " t.e "ne -.i1.e,entuay e1"!es atigue$ an$ ea$s t" a
true ra1ture% :4
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PATH+PH;S<+=+>;
• N"r!a "ne re!"$eing "11urs se1"n$aryt" in1rease$ 1"!*ressi,e "r tensie "a$s "rin1rease$ "a$ re?uen1y% <n t.e n"r!a
*.ysi""gi1 res*"nse !in"r !i1r"$a!age" t.e "ne "11urs%
• T.is is re*aire$ t.r"ug. re!"$eing% Stressra1tures $e,e"* -.en e8tensi,e
!i1r"$a!age "11urs e"re t.e "ne 1ane a$e?uatey re!"$ee$% @74
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ET<+=+>;
Stress ra1ture resut r"! re11urent an$re*etiti,e "a$ing " "ne%
T.e 3 a1t"rs t.at 1an *re$is*"se an in,i$uas
t" t.e $e,e"*!ent " stress ra1ture are #% An in1rease in t.e a**ie$ "a$
2% An in1rease in t.e nu!er " a**ie$ stress
3% A $e1rease in t.e sura1e area " t.ea**ie$ "a$% 4
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Ris' Fa1t"rs
• &enstrua $isturan1e
• Ca"ri1 restri1ti"n
• 5e1rease$ "ne $ensity
• &us1e -ea'ness
• =eg eng.t $iBeren1e 04
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E*i$e!i""gy
• ase$ "n "1ati"n an$ a1ti,ity
Location of Fracture Activity Involved
Metatarsals, general F""ta as'eta gy!nasti1s aet !iitary training204
Metatarsal, base of the second aet
Metatarsal, fth Tennis2 224 aet
Sesamoids of the foot Running aet as'eta s'ating
Navicular as'eta ""ta running
Talus P"e ,auting
Calcaneus &iitary $ris running aer"i1s
Fibula Running aer"i1s aet ra1eD-a'ing
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Tibia unning s!orts, dancing, ballet
"atella Running .ur$ing
Femoral nec# 5istan1e running !iitary training234
"ubic rami &iitary $ris $istan1e running
"ars articularis >y!nasti1s aet 1ri1'et ,"eya $i,ing ""ta
Chest, ribs S-i!!ing24 g"2:4 r"-ing2@4
Sternum Wresting274
$lna Ra1?uet s*"rts ,"eya
%lecranon asea t.r"-ing s*"rts
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7/18/2019 Stress Fracture Edited
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• ase$ "n se8
DStu$ies " US !iitary re1ruits re,eae$ a
.ig.er *er1entage " stress ra1tures ine!ae re1ruits t.an in !ae re1ruits%
D enne et a as" "un$ a : in1i$en1e "
stress ra1tures in 1"!*etiti,e e!aerunners 229304
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• ase$ "n ra1e
D <n a stu$y " !iitary re1ruits &ar'ey "un$
n" $iBeren1e in t.e in1i$en1e " stressra1tures et-een re1ruits " ,ari"us ra1iaa1'gr"un$s% 334
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Cini1a Presentati"n
• Hist"ry
- Wit. stress ra1tures t.e ty*i1a 1"!*aintis t.at " an insi$i"us "nset " *ain -it.
a1ti,ity "r a 1"!*aint " *ain in t.eaBe1te$ e8tre!ity -it. re*eate$ "a$ing%
- T.e *ain susi$es at rest ut sy!*t"!sreturn -.en t.e *atient resu!es t.e"rigina a1ti,ity%
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• P.ysi1a E8a!inati"n
- T.e 1"!!"n 6n$ings "n *.ysi1ae8a!inati"n !ay in1u$e ten$erness "r
*ain "n *a*ati"n "r *er1ussi"n " t.e"ne%
- Eryt.e!a "r e$e!a !ay e *resent at t.esite " t.e stress ra1ture%
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5iagn"sti1 Testing
• Ra$i"gra*.y
D Stress ra1tures !ay n"t s."- u* "n
ra$i"gra*.s "r t.e 6rst 2D -ee's aterinjury% T.e 6rst ra$i"gra*.i1 6n$ing !ay ea "1aie$ *eri"stea rea1ti"n "r anen$"stea 1"rti1a t.i1'ening%
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7/18/2019 Stress Fracture Edited
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• Te1.teniu!D99! "ne s1anning
D Te1.netiu! "ne s1an 6n$ings !ay e
*"siti,e in t.e 1ase " a stress ra1tureater 72 ."ursG ."-e,er a *"siti,e "nes1an 6n$ing is n"ns*e1i61 an$ it !ay ein$i1ati,e " an"t.er $iagn"sis su1. as anine1ti"n "r a ne"*asti1 *r"1ess%
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7/18/2019 Stress Fracture Edited
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• &agneti1 Res"nan1e <!aging
- T.e &R< 6n$ings " stress ra1tures ty*i1ay
""- " 2 *atterns%- <n t.e 6rst *attern a .y*"intense an$i'e
ra1ture ine is ,isie -it. surr"un$ing "ne "rtissue e$e!a%
-
T.e se1"n$ &R< 6n$ing re*resents an a!"r*."usstress ra1ture "r res*"nse *attern% 3:3@374
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7/18/2019 Stress Fracture Edited
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• >ra$ing " Stress Fra1tures "n t.e asis "Ra$i""gi1 Fin$ings 23:4
&rade adiogra!hic
Finding
'one Scan Finding MI Finding
( N"r!a P""ry $e6ne$ area <n1rease$ a1ti,ity "n
ST<R i!age
) N"r!a &"re intense P""r $e6niti"n "n
ST<R an$ T2D-eig.te$
i!ages
* 5is1rete ine S.ar* area " u*ta'e N" "1a "r usi"r!
1"rti1a rea' "n TD
an$ T2D-eig.te$i!ages
+ Fra1ture "r *eri"stea
rea1ti"n
&"re intense
"1aie$ trans1"rti1a
u*ta'e
Fra1ture ine "n TD
an$ T2D-eig.te$
i!ages
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Treat!ent
- &"st stress ra1tures 1an e treate$ y.a,ing *atients st"* "r signi61anty
$e1rease t.eir a1ti,ity "r a**r"8i!ateyD@ -ee's%
- Patients -it. *ain -it. -a'ing !ay e*a1e$ in a s."rt eg 1ast -it. 1rut1.es a
-a'ing ""t "r a ra1e "r D@ -ee's% 23A4
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Heaing ti!es "r ,ari"us stress ra1tures 394
Site of Stress Fracture "ercentage ealed at
)-+ .#, /
"ercentage ealed at
(-) mo, /
"ercentage ealed at
0 ) mo, /
Tibia, !ro1imal third 0 3 :7
Tibia, middle third 0 :2
Tibia, distal third 0 :3 7
Fibula 7 7:
Metatarsals 20 :7 23
Sesamoids 0 0 00
Femur, shaft 7 7 @
Femur, nec# 0 0 00
"elvis 0 29 7:
%lecranon 0 0 00
2Ada!ted from ul##o 3Findings .ere from a case series of *45 stress fractures in athletes, in
.hich the healing times of stress fractures in di6erent locations .ere assessed78
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Pre,enti"n
- Nutiti"na !easures #
1a1iu! an$ ,ita!in 5 ri1. ""$ 04
- i"!e1.ani1a !easures #
T.e use " "rt."ti1 $e,i1es an$ s."einserts .as een stu$ie$ as a *re,enti,e!easure "r "-erDe8tre!ity stressra1tures% 4
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C"!*i1ati"ns
• Hig. ris' stress ra1tures
D N"nuni"n " stress ra1tures is un1"!!"nut it 1an "11ur% T.ese in1u$e stress
ra1tures " t.e ne1' " t.e e!ur t.eanteri"r 1"rte8 " t.e tiia t.e tarsana,i1uar an$ t.e ases " t.e se1"n$ an$6t. !etatarsas% 2394
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• ="- ris' stress ra1ture
D ="-Dris' stress ra1tures in1u$e !"stu**erD e8tre!ity stress ra1tures -it. t.e
*"ssie e81e*ti"n " ra1tures t.r"ug. t.e*.ysis " t.e .u!era .ea$ (itte eaguerIss."u$er) an$ ra1tures t.r"ug. t.e !e$iae*i1"n$ye (itte eaguerIs e"-)% 2394
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D +t.er "-Dris' stress ra1tures in1u$estress ra1tures " t.e ris *e,is e!"ras.at 6ua 1a1aneus an$ t.e !etatarsa
s.ats%
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TAN9 :%$