Stress fracture
definition
The term stress fracture is also used Fatigue fracture called and means a broken bone caused by a permanent Overloading the bone in the mechanical sense is caused. Such stress fractures occur mainly on bones that have to support a large proportion of our body weight, i.e. mainly on the Legs and Feet.
Stress fractures are not caused by a traumatic event like other broken bones, but arise during a longer time. Constant overloading of certain bones and joints, e.g. through certain sports like Long distance running the bone is damaged more and more until it finally breaks.
Causes of a stress fracture
Basically, a Stress fracture of the Insufficiency fracture distinguished.
The Stress fracture is created by a permanent overloading of an otherwise healthy bone and joins most often Competitive and endurance athletes on.
The Insufficiency fracture however occurs for previously damaged bones on when the bone structure due to a bone disease like Rheumatoid arthritis, rickets or osteoporosis has already been damaged.
In the case of a stress fracture, permanent overloading or too frequent, too long or incorrect stress is the cause. It gradually emerges fine cracks in the bone substance, so-called Microfractures. These usually heal again after a while, but not when the glight load persists.
This is particularly common in certain sports, such as Long distance running. In particular through Training mistakes stress fractures occur here.
There is also the so-called Cough fracturein which a chronic, strong cough can break ribs or vertebral body processes.
Certain circumstances can be described as risk factors, so that with certain training methods a stress fracture can occur in otherwise healthy bones. So can one sudden change in running speed, a too hard surface or one Weight gain be responsible for a stress fracture. A low muscle mass, a low calf circumferenceg, a diet or certain drugs (such as cortisone) can promote the development of a stress fracture.
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Symptoms of stress fracture
Because a fatigue fracture is not caused by an acute traumatic event, but rather developed slowly, are also other symptoms characteristic of a stress fracture.
In contrast to normal fractures, where patients report a sudden pain event as part of an injury, stress fractures initially only occur light pain on. These often exist initially only under stress and only later at rest.
Other possible symptoms of a stress fracture are one Swelling over the corresponding bone, such as Redness and overheat. The resilience of the corresponding structures also gradually decreases, so that those affected do not immediately think of a broken bone. The diagnosis frequently with delay posed.
Stress fracture pain
A stress fracture is in contrast to a normal bone fracture no acute pain event in the foreground. Rather, the person concerned first notices first slight painthat only occur when exposed to stress. With prolonged exertion the pain can stronger will and eventually in peace occur. The character of pain can vary from piercing to dull pass.
Diagnosing a stress fracture
A stress fracture is often only due to the lengthy process recognized late and diagnosed. The complaints often include Pain, swelling and overheat initially thought of rheumatic complaints.
A exact anamnesis and the Pattern of overload are therefore very useful for making a diagnosis important.
To confirm the suspicion, a Imaging respectively. A X-ray is only suitable to a limited extent, especially in the early stages of the stress fracture fine fracture lines often in x-rays not visible. in the CT a stress fracture can judged better become. However, a stress fracture or its precursors (such as microfractures) are best resolved in the MRI (Magnetic resonance imaging) or with a Skeletal scintigraphy detect.
Partly have to Other diseases like bone inflammation (Osteomyelitis) or benign and malignant bone tumors locked out become. This can be done in part by a Blood collection or one Tissue sample respectively.
Treatment of a stress fracture
Treatment for a stress fracture depends on several factors.
First of all, it is crucial whether first Precursors of a fracture (such as microfractures) or a manifest fracture. In the case of preliminary stages of a fracture, it may be sufficient to begin with To expose them to permanent load. If the stressful activity is stopped, the affected bone has time to close regenerate.
Is a fracture already manifest (pronounced), one must specific therapy respectively. This therapy depends on the location of the hernia and the severity of the fracture. In some cases is a conservative care with a plaster cast sufficient to relieve the bone so that it can regenerate. In other cases are operational procedures necessary to a permanent bone healing to reach.
Depending on the location of the fracture and its severity certain nails or the Use of plates and screws in question. In other cases the surgeon can ask Piece of healthy bone from the iliac crest remove and insert at the break point.
Followed by a Immobilization from up to four weeks respectively. This gives the injured bone time to regenerate. The burden on the affected part of the body should then only slowly increased again to avoid relapse. A physical therapy can be supportive here.
Duration of a stress fracture
The time it takes for a stress fracture to heal varies greatly from person to person and depends on several factors.
First of all, it is crucial whether already a manifest fracture present, or only Preliminary stages.
Early stages heal under immobilization by a plaster cast or splints and bandages mostly within 6 to 8 weeks from.
Manifest fractionswho need a cast or surgery will also need one Immobilization for several weeks. Physiotherapy can have a supportive effect and positively influence the course of the disease.
A complete one Waiver on the triggering stress (e.g. running sports) is absolutely necessary. A gradual increase in the load on the corresponding part of the body up to full load should definitely be discussed with the attending physician in order to avoid relapses.
Different locations of a stress fracture
Stress fracture of the knee
Does the knee joint become a excessive stress exposed, stress fractures of the bony structures involved can occur.
In the knee joint are the Thigh (femur), the Fibula and the Shinbone (tibia) connected with each other. For example, the head of the fibula (fibular head) can fracture (break). It is the head of the fibula that can be felt on the outside at the bottom of the knee. Since it is very narrow and graceful, it is especially at Turning movements in the knee very prone to stress fractures. The consequences are creeping pain and a increasing restriction of movement in the knee joint.
A stress fracture in the knee area can also be right on the kneecap (Patella) arise. Especially in sports that do Put heavy weight on the knees like for example Gymnastics or dancing, it can happen that the kneecap gradually tears further up to a stress fracture. Such a stress fracture is particularly evident in Knee movements by Pain, swelling, or redness in the knee area.
Especially that Climb stairs is increasingly difficult for the affected patient, as the knee is particularly stressed. Usually a stress fracture in the knee can be treated well by immobilizing the knee.
However, the important thing in this phase is absolute renunciation on the stressful sport, otherwise serious consequential damage can occur. This would be in the knee area chronic movement restrictions and severe pain connected. The recommendations of the doctor regarding rest and gradual increase of the load must be followed.
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Stress fracture of the foot
The foot is straight in running sports exposed to heavy loads, since he is the carries full body weight. For this reason, stress fractures are particularly common here.
As part of regular long marching and hiking routes the stress fracture occurs particularly frequently in the area of the metatarsus, near the second toe on. The result is severe pain that intensifies when walking or running. The foot is as well swollen and can one reddish discoloration accept.
A stress fracture of the foot can be diagnosed by a Skeletal scintigraphy or a MRI can be reliably proven, but the diagnosis often cannot be confirmed by X-rays.
Once diagnosed, the stress fracture should urgently be relieved and immobilized. If the broken ends are in the area of the metatarsus, wearing a special Forefoot relief shoe adequate immobilization can be achieved. Decongestant measures such as Lymph node drainage and Kinesio taping be performed.
A fatigue fracture on the foot usually heals within four to six weeks completely off. However, the gradual build-up of the load should always be done in consultation with the doctor.
Stress fracture of the tibia
Due to permanent overload, it can also occur in the Shinbone (tibia) come to the stress fracture. The most common cause is here excessive jogging, such as changed training habits, Weight changes or one to hard ground.
Show up as a typical symptom Painthat initially creeping and only under pressure occur. The pain increases over time and then also occurs at rest. Also one swelling and Redness in the area of the shin are possible.
The therapy usually consists of one several weeks of immobilization of the respective leg. This often requires a plaster cast be created. In more complicated cases, a operative care respectively. Here, the ends of the bones are connected to one another with screws or metal plates. In case of surgical therapy takes place the Healing usually much faster and the resilience can be increased faster.
Stress fracture of the fibula
The fibula is inclined in two areas especially for the formation of a stress fracture;
1) in the area of the knee, i.e. on the Fibular head or
2) in the lower part of the fibula, which the Outer ankle forms.
Very rarely breaks the fibula central, then more by one "Normal" break as a result of a acute trauma.
In the area of Outer ankle (Malleolus lateralis) can occur especially in one persistent overload while long marches or at to jog come to a stress fracture.
This manifests itself through recurring Swelling around the ankle as well as through Redness and Appearance pain.
The pain will be under pressure, especially when jumping or jogging, worse. Especially frequent twisting Not only puts strain on the ligaments and muscles, but can also Stress fractures in the lower fibula or in Outer ankle to lead. Suspension of training and immobilization of the ankle are absolutely necessary to achieve regeneration of the bone and to prevent the symptoms from progressing. Here too there is Possibility of conservative or surgical therapy, the choice depends on the extent and complexity of the stress fracture.
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Stress fracture of the calcaneus
A stress fracture of the Heel bone (calcaneus) is common very painful.
The most common cause here is one excessive stress from running or walkingso some sports like hike or to jog represent a particular predisposition.
Affected is a Stepping on the heel is almost impossibleso they have a changed gait accept. Furthermore, the heel often shows a swelling and Redness.
After the diagnosis has been made using an imaging procedure, in principle a conservative or one surgical supplies respectively.
A uncomplicated stress fracture can mostly with one simple plaster cast be treated. Have a pain reliever Ibuprofen or Paracetamol. The heel must now be for spared approx. 14 days be to the bone Time to regenerate to grant. Has the break moved (dislocated) or lies a Involvement of the ankle before so is a surgical intervention required.
Here, the broken ends are brought back into a straight position and then through Wires or plates fixed to each other. Depending on the type of material, it has to be removed a few months later. Even after an operation, the foot will suffer in plasterto get a Ensure immobilization.
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Stress fracture of the pelvis
A stress fracture of the bones involved in the pelvic ring is a principle rather seldom.
The reason for this is that the pelvis does not have the same weight as the foot or leg and the bone a lot here more stable are. But even here stress fractures in particularly endangered areas are conceivable due to stressful sports like jogging, dancing or gymnastics.
For example, jogging can lead to a sacrum fracture. Here is that too Resignation from the initiating activity, mostly the sport, absolutely necessary. Since absolute immobilization in the pelvis can only be achieved through bed rest, compromises have to be made here, but the renouncement of exercise is essential. In some more complicated cases it must operational The fracture can be stabilized using plates and screws.
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