Stress

Fractures
By
Michael LaBella
Bone Stress Continuum:

Stress Reaction Stress Fracture
Stress Fractures
Stress Reaction:
accelerated adaptive bone remodeling
most often asymptomatic
occurs most often in tarsals, metatarsals, femur, & tibia
sometimes seen on X-ray as increased callus deposition

Stress Fracture:
complete defect or crack in the bone
easily seen on X-ray
Causes
repetitive torque across a bone
weight bearing impact forces
bone does not adapt as well as
muscle r u risk of injury becoming
chronic
inability of weak musculature to
facilitate shock absorption
Occurs in high impact sports; football, soccer,
cross country
intensity and / or volume of activity is not
natural
Most stress fractures heal by themselves without
clinical manifestations
Stress fractures u risk of complete fracture at the
stress fracture site
Early stage stress fractures (stress reactions)
dont show up well on X-rays
better detected by bone scan - shows up as
hot spots
Stress Fractures
Symptoms
tenderness & pain over the fracture site
pain relieved by rest but becomes
progressively more frequent &
persistent
overlying soft tissue may exhibit
swelling
tuning fork struck and placed over the
fracture site will elicit pain
muscle atrophy



Examples of Stress Fractures:
tibial stress fracture in runners
weight bearing impact related
humerus stress fracture in javelin
thrower
related to muscle trying to accelerate a
resisting bone (torque)
Stress Fractures
Types of stress fractures

Oblique / Transverse
angled to or perpendicular to the long axis
of the bone
most common
most dangerous due to the likelihood of
bone displacement
Longitudinal
Compression

Stress Fracture of Left Tibia
Bone Scan
"Hot Spot"
Corresponding
X-ray
Stress
Fracture
Site
Bilateral Stress Fractures of the Ulna in a Weight Lifter
"Hot Spots"
Stress Fracture of
3rd Metatarsal
Stress Reaction of
Calcaneous in Runner
Stress Fractures
Stress
(load)
Complete
Failure
(Rupture)
Toe Region
straightening
of collagen
fibers
Elastic Range
Plastic Range
Fiber
Necking
hysteresis
loop
representing
heat loss
New resting length
after stretch
Strain (% deformation)
length of
stretch
*
STRESS - STRAIN CURVE OF MUSCULOTENDINOUS TISSUE
fibers require
substantial
tension to
deform and will
return to
original shape
after stretch
stretched fibers
will not return to
original length
slope of curve in
this region is an
index of tissue
stiffness
Resting
Length
(Partial tearing of fibers)
*
*
Elastic Limit
Increased Mechanical Load
Beyond Tissue Tensile Strength
Submaximal Stress
Repetitive
Impact - Contact
Microfailure
(partial rupture)
Macrofailure
(complete rupture)
Failed Healing
Response
Acute
Inflammation
Classic Inflammatory Syndrome
(Tendinosis Tendinitis) and / or
Healing
Degenerative
Changes Within
Fibrosis
Degenerative Changes
in Tissue Sheath
Sheath Increased
Inflammation
Continuation of
Injurous Activity
Decreased Functionality
Increased Chronicity
Exacerbation of Injury
Rest Treatment
Initial Cell-Matrix Response
(Reversible Injury - Possibly No Pain)
Physiological Adaptation
(Training Effect)
+ Prenchymal Tissue
+
Increased Fibrotic Response
Healing of
Microtraumatic Injuries