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stress fracture (fatigue fracture)

Classification: - fatigue fracture - stress insufficiency facture* * MKSAP19 confuses stress insufficiency fractures with minimal trauma fractures or osteoporotic fractures referring to them as stress fractures Etiology: - fracture of a bone that occurs as the result of repetitive stress, generally transverse in configuration. Pathology: - most commonly occurs in metatarsals, tarsals & calcaneus [2] - stress insufficiency fractures* typically occur in the spine, sacrum, pelvis, or knee (MKSAP19) * these are osteoporotic fractures but MKSAP19 calls them stress fractures Clinical manifestations: - pain with percussion - pain hopping on one leg [2] Radiology: - plain radiography (X-ray) 1st line but may fail to show fracture line [2] - bone densitometry (female distance runner with low BMI & amenorrhea) [3] Differential diagnosis: - minimal trauma fracture (osteoporotic fracture, insufficiency fracture) Management: - depends on risk of non-union, determined largely by location of fracture - stress fractures at high risk of non-union include fractures of: - base of 2nd metatarsal - 5th metatarsal diaphysis - medial malleolus - reduce activity to achieve pain-free function - gradual return to pain-free activity

Related

minimal trauma (pathologic, osteoporotic, fragility, insufficiency) fracture

Specific

calcaneus stress fracture metararsal stress fracture (march fracture) subtrochanteric stress fracture tibial stress fracture

General

bone fracture

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021
  3. NEJM Knowledge+ Rheumatology
  4. Matcuk GR Jr, Mahanty SR, Skalski MR, et al. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2016;23:365-75. PMID: 27002328