Stress Fracture Edited

7/18/2019 Stress Fracture Edited

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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



+,er,ie-

T.e stress ra1ture is a 1"!!"n ",eruseinjury seen in at.etes an$ !iitaryre1ruits% 24



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



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



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



Ris' Fa1t"rs

• &enstrua $isturan1e

• Ca"ri1 restri1ti"n

• 5e1rease$ "ne $ensity

• &us1e -ea'ness

• =eg eng.t $iBeren1e 04



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



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



• 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



• 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



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%



• 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%



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%



• 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%



• &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



• >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



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



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



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



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



• ="- 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



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%



TAN9 :%$

Stress Fracture Edited

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