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Stress Fracture

David A. Ross, MD, CAQSM and Nicole A. Ross, DO Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Overuse injuries caused by cumulative microdamage from repetitive bone loading

  • Stress fractures occur in different situations:

    • Fatigue fracture: abnormal repetitive stress applied to n...

DIAGNOSIS

HISTORY

  • Insidious onset of vague bony pain over period of weeks. Pain is typically worse with physical activity.

  • Rest initially relieves pain.

  • If untreated, pain progresses and may occur earlie...

TREATMENT

  • Grade I to grade II and low-risk stress fractures are generally treated nonoperatively, including non–weight-bearing and immobilization (5)[C].

  • Grade III to grade V and high-risk stress fract...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Once the patient is pain free, low-impact training can start and be advanced gently as tolerated.

  • Once running has resumed, increase mileage slowly no more than 10...

REFERENCES

1
Matcuk GRJr, Mahanty SR, Skalski MR, et al. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol.  2016;23(4):365–375. [View...

ADDITIONAL READING

Miller TL, Best TM. Taking a holistic approach to managing difficult stress fractures. J Orthop Surg Res.  2016;11:98. [View Abstract on OvidMedline] 

SEE ALSO

Algorithm: Foot Pa...

CODES

ICD10

  • M84.38XA Stress fracture, other site, initial encounter for fracture

  • M84.369A Stress fracture, unsp tibia and fibula, init for fx

  • M84.376A Stress fracture, unspecified foot, init encntr for f...

CLINICAL PEARLS

  • The diagnosis of stress fractures requires a high index of suspicion. X-rays are often negative initially.

  • Identify and treat female athletic triad to prevent stress fractures.

  • To help p...

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