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Review
. 2023 Nov;126(11):848-855.
doi: 10.1007/s00113-023-01339-4. Epub 2023 Jun 21.

[High-risk stress fractures in competitive athletes]

[Article in German]
Heinz Lohrer  1   2
Affiliations
Review

[High-risk stress fractures in competitive athletes]

[Article in German]
Heinz Lohrer. Unfallchirurgie (Heidelb). 2023 Nov.

Abstract
in English, German

Bone stress injuries are chronic overload reactions of the bone, which are characterized by the load-dependent occurrence of locally perceived pain and tenderness on palpation at the site of the injury. Structurally normal bone becomes fatigued as a result of repetitive submaximal loading and/or inadequate regeneration. Certain stress fractures of the femoral neck (tension side), patella, anterior tibial cortex, medial malleolus, talus, tarsal navicular bone, proximal fifth metatarsal, and sesamoid bones of the great toe tend to develop complications (complete fractures, delayed union, pseudarthrosis, dislocation, arthrosis). These injuries are classified as high-risk stress fractures. Aggressive diagnostics and treatment are recommended when a high-risk stress fracture is suspected. Treatment is frequently different from low-risk stress fractures, including prolonged non-weight-bearing immobilization. In rare cases, surgery is indicated when conservative treatment fails, when a complete or non-healing fracture develops, or in cases of dislocation. The outcomes of both conservative and operative treatment are described as less successful compared with low-risk stress injuries.

Knochenstressverletzungen sind chronische Überlastungsreaktionen des Knochens, die durch belastungsabhängig auftretende, fokal empfundene Schmerzen und punktuelle Druckdolenz am Ort der Verletzung gekennzeichnet sind. Der strukturell normale Knochen ermüdet aufgrund repetitiver submaximaler Belastungen oder/und nichtadäquater Regeneration. Bestimmte Belastungsfrakturen des Oberschenkelhalses (Zugseite), der Kniescheibe, der vorderen Tibiakante, des Innenknöchels, des Talus, des Os naviculare pedis, des proximalen 5. Mittelfußknochens und der Sesambeine unter dem Metatarsale-I-Köpfchen neigen zu Komplikationen (komplette Fraktur, verzögerte Heilung, Pseudarthrose, Dislokation, Arthrose). Diese Verletzungen werden als Hochrisiko (High-risk)-Stressfrakturen bezeichnet. Bei Verdacht auf eine High-risk-Stressfraktur müssen die Diagnostik und Therapie „aggressiv“ erfolgen. Vollständige Ruhigstellung ohne Belastung oder Operation müssen individuell in Betracht gezogen werden. Die Ergebnisse sowohl der konservativen als auch der operativen Behandlung werden im Vergleich zu Low-risk-Stressverletzungen als weniger gut beschrieben.

Keywords: Athletic injuries; Bone stress reaction; Diagnostic imaging; Load restriction; Overloading.

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