Stress fractures and overuse injuries in children and adolescents

Abstract

There is an intricate connection between physical activity, bone health, and the susceptibility to stress fractures and overuse injuries. Physical activity has a positive impact on bone strength while a sedentary lifestyle can lead to a heightened risk for injury. The rise of early sports specialization has led to a substantial increase in overuse injuries, particularly in individual sports.Bone Stress Injuries (BSI) represent a category of overuse injuries closely linked to single sport specialization. BSI involves a spectrum of altered bone mechanics, ranging from edema of periosteum, endosteum, and bone; potentially leading to partial or full cortical breaks. This condition is prevalent in high-level athletes and encompasses stress reactions and fractures, resulting from an imbalance between injury creation and repair. Up to 20% of adolescents are affected, with the tibia being the most common location, predominantly occurring in athletes aged 15 to 25. A holistic approach integrating both physical and nutritional aspects is warranted to ensure sustained musculoskeletal health across diverse pediatric and adolescent groups and athletic endeavors.

Key concepts: (1)Early and single sports specialization has a substantial impact on overuse injuries.(2)Bone stress injuries are common in high-level athletes resulting from an imbalance between creation and repair of injury.(3)Relative energy deficiency in sports (REDS) is related to a higher risk for recurrent Bone Stress Injuries.(4)Athletes that are lacking vitamin D are found to have an increased risk for stress fractures.

Keywords: Adolescent stress injuries; Bone health; Overuse.

Figure 1

Distal humerus medial epicondyle avulsion fracture in a 13-year-old male baseball pitcher.

Figure 2

Little League Shoulder in a 15-year-old male baseball pitcher as seen with the widening of the proximal humerus growth plate.

Figure 3

Tibial stress fracture visible on plain radiograph and MRI.