Stress Fracture

Question 1

Any fracture or microfracture that occurs as the result of repetitive cyclic insults rather than by one traumatic event (load failure).

Answer 1

STRESS FRACTURES

• Increase in osteoclastic activity and micro-fractures of trabecular bone

Question 2

Occurs in normal bone when increased stress occurs

Most common form you will see

Answer 2

Fatigue Fracture

Question 3

Occurs in abnormal bone weakened by an underlying disease or condition (arthropathy, metabolic bone disease, osteoporosis), without increase in stress needed

Answer 3

Insufficiency/Fragility Fracture

Question 4

Occurs in bone invaded by a tumor/other disease process (ie, aneurysmal bone cyst, osteomyelitis)

Answer 4

Pathologic Fracture

Question 5

________-leads to decrease in bone density

Surgery, injury

Answer 5

Prolonged NWB

Question 6

Decreased bone mineral density can be a result of ______

Answer 6

*Vitamin D deficiency

Question 7

Responsible for osteoclast-suppressing activities and preventing osteoblastic suicide

Answer 7

Estrogen/Hormone levels

• A decline in estrogen triggers an osteoclast production explosion which increases bone turnover and the amount of remodeling

Question 8

Stress fractures often develop from overuse-repeated stress of foot striking the ground

Answer 8

Extrinsic Factors for develpoment of stress factors

-

Question 9

Extrinsic Factors

Answer 9

Change of surface
Nutritional Status/Diet
Medications
Training Regimen: Error in training or technique

Question 10

Eating disorders
Irregular menstrual cycle
Osteoporosis

Answer 10

Female Triad

Question 11

Estrogen is responsible for suppression of osteoclasts and for keeping osteoblasts alive

Answer 11

Estrogen

Question 12

2nd and 3rd ____), followed by 4th and 5th

Answer 12

28%

• 2-4 march fractures
• 2 and 3 most common

Question 13

Flat foot with metatarsus adductus or prominent 5th met base

Answer 13

Predisposed to 5th met fracture

Question 14

5th Metatarsal: Torg Classification

No previous fracture
Acute fracture line with sharp edges

Answer 14

Type 1

Question 15

5th Metatarsal: Torg Classification

No previous injury or fracture
Fracture line involves both cortices
Periosteal new bone and intramedullary sclerosis

Answer 15

Type 2

Question 16

5th Metatarsal: Torg Classification

Answer 16

Type 3

Question 17

Pain localized to ‘N’ Spot- Small area approximately the size of a nickel

Central 1/3rd most common area due to vascular supply

Answer 17

Navicular Stress fracture

-make non weight bearing

Question 18

Early diagnosis and treatment ….

Answer 18

is key

Question 19

Pressure to the top of the metatarsal, not the bottom, will produce pain

Answer 19

Metatarsals:

Question 20

Side to side compression/squeeze test for calcaneus

Answer 20

Calcaneus:

Question 21

____scan and____I can be utilized to help verify extent of fracture seen on bone scan, or help distinguish fracture from infection

Answer 21

CT

MRI

Question 22

__________ of inciting activity paramount
Will reverse destructive phase
If not utilized, will develop much more extensive fracture

Answer 22

Rest and cessation

Limit activity for minimum 3-4 weeks

Pain is a good guide for progression to activity