![]() General treatment for stress fractures can be grouped into nutrition, medication, and biomechanical recommendations. Additionally, women of child bearing age should try to maintain regular menses by consuming adequate calories and avoiding a negative energy balance. A study by Lappe of female Navy recruits showed reductions in stress fractures in those consuming 2000 mg of calcium 1 and 800 IU vitamin D 1 daily, either as a supplement or through consumption of dairy products. To prevent stress fractures, athletes should distribute loading forces on the bone with cross training and biomechanical adjustments (i.e., orthotics, proper shoes, stretches, strengthening, running mechanics), consume sufficient calories to maintain adequate energy availability, and ensure appropriate intake of calcium and vitamin D. Because a bone scan can stay positive for up to 18 months, clinical progress should not be monitored with a bone scan. The bone scan and MRI are equally sensitive, but an MRI is more specific and avoids patient radiation exposure. If x-rays are negative and a diagnosis is needed to help guide care and RTP, a bone scan or MRI with T2 fat saturation views ( Figures 20 and 21) should be obtained. If a stress fracture is suspected, x-rays should be obtained, keeping in mind that it takes 2 to 3 weeks for signs of stress fracture (i.e., periosteal reaction, callus formation, fracture line) to show up on an x-ray, and often stress fractures do not show up on x-rays. ![]() Physical examination tests to perform in the area of interest are palpation, the tuning fork test, the fulcrum test, and the hop test ( Table 3). Stress fractures should be considered in someone who is active, presents with bone pain, and who performs repetitive activities with limited rest or with a recent increase in activity. Running sports account for 69% of stress fractures. Stress fractures are common injuries in athletes and occur most often in the lower extremities. This can occur as a result of excessive stress on normal bone from overactivity or normal stress on a bone that is deficient (osteoporotic, poor nutrition, or in female athlete triad). Bone injury unfolds over a continuum of time, starting with normal bone that progresses to stress reaction, then stress fracture, and finally fracture if the bone continues to be injured. Stress fractures occur when osteoclastic activity overwhelms osteoblastic activity. Kellerman MD, in Conn's Current Therapy 2021, 2021 Stress Fractures
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