Analysis of stress fractures in athletes based on our clinical experience

Abstract

Aim: To analyze stress fractures in athletes based on experience from our sports medicine clinic.

Methods: We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis.

Results: During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad.

Conclusion: The results of this analysis showed that stress fractures were seen in high-level young athletes, with similar proportions for males and females, and that particular sports were associated with specific sites for stress fractures. Middle and long distance female runners who suffered from multiple stress fractures had the female athlete triad.

Keywords: Athletes; Bone mineral density; Female athlete triad; Stress fracture; Vitamin D insufficiency.

Figure 1

A case of stress fracture of the tibia diagnosed by technetium 99m-labeled bone scan. Although there were no abnormal findings on the plain radiographs of the tibia, the bone scan showed the uptake of technetium 99m in the tibial diaphysis. The localized focal uptake of technetium 99m suggests a stress fracture.

Figure 2

A case of stress fracture of the medial malleolus of the tibia. Although there were no abnormal findings on the plain radiographs of the ankle, the bone scan showed the uptake of technetium 99m in the medial malleolus of the tibia. The localized focal uptake of technetium 99m suggests a stress fracture.