Skip to main content
SpringerLink
Log in

Stress fractures: Current concepts

  • Articles
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

1. Stress fractures result from muscular activity on bones rather than from direct impact upon them. 2. The fatigue variety of stress fracture occurs in normal bone when abnormal muscular tension or torsion is placed upon it. 3. The insufficiency type of stress fracture results when normal muscular stress is placed upon a bone with deficient elastic resistance. 4. Most stress fractures are of the fatigue type, occurring in an individual who engages in repetitive vigorous activity to which he is unaccustomed. 5. The biomechanics, radiologic features, and differential diagnosis were discussed and the literature was reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blickenstaff, L.D., Morris, J.M.: Fatigue fracture of the femoral neck. J. Bone Joint Surg. [Am] 48, 1031 (1966)

    Google Scholar 

  2. Bowerman, J.W.: Radiology and Injury in Sport. pp 131–133, 260–263. New York: Appleton-Century-Croft 1977

    Google Scholar 

  3. Bowerman, J.W.: Radiology and Injury in Sport. pp 289–290. New York: Appleton-Century-Croft 1977

    Google Scholar 

  4. Bowerman, J.W.: Radiology and Injury in Sport. pp 289–290. New York: Appleton-Century-Croft 1977

    Google Scholar 

  5. Brooks, D.B., Burstein, A.H., Frankel, V.H.: The biomechanics of torsional fractures: The stress concentration of a drill hole. J. Bone Joint Surg. [Am] 52, 507 (1970)

    Google Scholar 

  6. Burrows, H.J.: Fatigue infraction of the middle of the tibia in ballet dancers. J. Bone Joint Surg. [Br] 38, 83 (1956)

    Google Scholar 

  7. Carter, P.R., Eaton, R.G., Littler, J.W.: Ununited fracture of the hook of the hamate. J. Bone Joint Surg. [Am] 59, 583 (1977)

    Google Scholar 

  8. Chamay, A.: Mechanical and morphological aspects of experimental overload and fatigue in bone. J. Biomech. 3, 263 (1970)

    Google Scholar 

  9. Chamay, A., Tschants, P.: Mechanical influence in bone remodeling. Experimental research on Wolff's law. J. Biomech. 5, 173 (1972)

    Google Scholar 

  10. Cummings, C.W., First, R.: Stress fracture of the clavicle after a radical neck dissection: Case report. Plast. Reconstr. Surg. 55, 366 (1975)

    Google Scholar 

  11. Cyron, B.M., Hutton, W.C., Troup, J.D.G.: Spondylolytic fracture. J. Bone Joint Surg. [Br] 58, 462 (1976)

    Google Scholar 

  12. Devas, M.: Stress fracture of the tibia in athletes or ‘shin soreness’. J. Bone Joint Surg. [Br] 40, 227 (1958)

    Google Scholar 

  13. Devas, M.: Compression stress fracture in man and the grey-hound. J. Bone Joint Surg. [Br] 43, 540 (1961)

    Google Scholar 

  14. Devas, M.: Stress fractures in children. J. Bone Joint Surg. [Br] 45, 528 (1963)

    Google Scholar 

  15. Devas, M.: Stress Fractures. pp. 1–18, 224–235. London: Churchill Livingstone 1975

    Google Scholar 

  16. Devas, M.: Stress Fractures. pp. 107–137. London: Churchill Livingstone 1975

    Google Scholar 

  17. Devas, M.: Stress Fractures. pp. 138–147. London: Churchill Livingstone 1975

    Google Scholar 

  18. Devas, M.: Stress Fractures. pp. 138–147. London: Churchill Livingstone 1975

    Google Scholar 

  19. Devas, M.: Stress Fractures. pp. 174–189. London: Churchill Livingstone 1975

    Google Scholar 

  20. Devas, M.: Stress Fractures. pp. 190–211. London: Churchill Livingstone 1975

    Google Scholar 

  21. Devas, M.: Stress Fractures. pp. 212–223. London: Churchill Livingstone 1975

    Google Scholar 

  22. Ernst, J.: Stress fracture of the neck of the femur. J. Trauma 4, 71 (1964)

    Google Scholar 

  23. Evans, D.L.: Fatigue fracture of the ulna. J. Bone Joint Surg. [Br] 37, 618 (1955)

    Google Scholar 

  24. Farfan, H.F., Osteria, V., Lamy, C.: The mechanical etiology of spondylosis and spondylosthesis. Clin. Orthop. 117, 40 (1976)

    Google Scholar 

  25. Ford, L.T., Gilula, L.A.: Stress fractures of the middle metatarsals following the Keller operation. J. Bone Joint Surg. [Am] 59, 117 (1977)

    Google Scholar 

  26. Frieberger, R.H., Edeiken J., Jacobson, H.G., Norman, A.: Bone Diseases (Second Series) Syllabus. pp. 192–214 Chicago: American College of Radiology 1976

    Google Scholar 

  27. Fulkerson, J.P., Ozonoff, M.B.: Multiple symmetrical fractures of bone of unresolved etiology. Am. J. Roentgenol. 129, 313 (1977)

    Google Scholar 

  28. Geslien, G.E., Thrall, J.H., Espinosa, J.L., Older, R.A.: Early detection of stress fractures using 99m Tc-polyphosphate. Radiology 121, 683 (1976)

    Google Scholar 

  29. Hadley, L.A.: Stress fracture with spondylolysis. Am. J. Roentgenol. 90, 1258 (1963)

    Google Scholar 

  30. Jones, H.H., Priest, J.D., Hayes, W.C., Tichenor, C.C., Nagel, D.A.: Humeral hypertrophy in response to exercise. J. Bone Joint Surg. [Am] 59, 204 (1977)

    Google Scholar 

  31. Kroening, P.M., Shelton, M.L.: Stress fractures. Am. J. Roentgenol. 89, 1281 (1963)

    Google Scholar 

  32. Laferty, J.F., Winter, W.G., Gambaro, S.A.: Fatigue characteristics of posterior elements of vertebrae. J. Bone Joint Surg. [Am] 59, 154 (1977)

    Google Scholar 

  33. Levin, D.C., Blazina, M.E., Levine, E.: Fatigue fractures of the shaft of the femur: Simulation of malignant tumor. Radiology 89, 883 (1967)

    Google Scholar 

  34. Michetti, M.L.: March fracture following a McBride bunionectomy, a case report. J. Am. Pediatry Assoc. 60, 286 (1970)

    Google Scholar 

  35. Milkman, L.A.: Pseudofractures (hunger osteopathy, late rickets, osteomalacia). Report of a case. Am. J. Roentgenol. 32, 622 (1934)

    Google Scholar 

  36. Miller, B., Markheim, H.R., Towbin, M.N.: Multiple stress fractures in rheumatoid arthritis. J. Bone Joint Surg. [Am] 49, 1408 (1967)

    Google Scholar 

  37. Miller, E.H., Schneider, H.J., Bronson, J.L., McLain, D.: A new consideration in athletic injuries. The classical ballet dancer. Clin. Orthop. 111, 181 (1975)

    Google Scholar 

  38. Murray, R.O., Jacobson, H.G.: The Radiology of Skeletal Disorders. pp. 260–271 Second Edition London: Churchill Livingstone 1977

    Google Scholar 

  39. Nand, S., Shukla, R.K.: Fatigue fractures of the femoral neck. Int. Surg. 61, 31 (1976)

    Google Scholar 

  40. North, K.A.K.: Multiple stress fractures simulating osteomalacia. Am. J. Roentgenol. 97, 672 (1966)

    Google Scholar 

  41. Pentecost, R.L., Murray, R.A., Brindley, H.H.: Fatigue, insufficiency and pathologic fractures. JAMA 187, 1001 (1964)

    Google Scholar 

  42. Pilgaard, S., Poulsen, J.O., Christensen, J.H.: Stress fractures. Acta Orthop. Scand. 47, 167 (1976)

    Google Scholar 

  43. Rappoport, A.S., Sosman, J.L., Weissman, B.N.: Spontaneous fractures of the olecranon process in rheumatoid arthritis. Radiology 119, 83 (1976)

    Google Scholar 

  44. Rasad, S.: Golfer's fractures of the ribs. Report of 3 cases. Am. J. Roentgenol. 120, 901 (1974)

    Google Scholar 

  45. Sandrock, A.R.: Another sports fatigue fracture. Stress fracture of the coracoid process of the scapula. Radiology 117, 274 (1975)

    Google Scholar 

  46. Savoca, C.L.: Stress fractures. A classification of the earliest radiographic signs. Radiology 100, 519 (1971)

    Google Scholar 

  47. Schneider, H.J., King, A.Y., Bronson, J.L., Miller, E.H.: Stress injuries and developmental changes of lower extremities in ballet dancers. Radiology 113, 627 (1974)

    Google Scholar 

  48. Schneider, R., Kaye, J.J.: Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis. Radiology 116, 595 (1975)

    Google Scholar 

  49. Sherman, F.C., Wilkinson, R.H., Hall, J.E.: Reactive sclerosis of a pedicle and spondylolysis in the lumbar spine. J. Bone Joint Surg. [Am] 59, 49 (1977)

    Google Scholar 

  50. Singer, M., Maudsley, R.H.: Fatigue fractures of the lower tibia: A report of five cases. J. Bone Joint Surg. [Br] 36, 647 (1954)

    Google Scholar 

  51. Stark, H.H., Jobe, F.W., Boyes, J.H., Ashworth, C.R.: Fracture of the hook of the hamate in athletes. J. Bone Joint Surg. [Am] 59, 575 (1977)

    Google Scholar 

  52. Stein, R.E., Stelling, F.H.: Stress fracture of the calcaneus in a child with cerebral palsy. J. Bone Joint Surg. [Am] 59, 131 (1977)

    Google Scholar 

  53. Sweet, D.E., Allman, R.M.: RPC of the month from the AFIP: Stress fracture. Radiology 99, 687 (1971)

    Google Scholar 

  54. Torg, J.S., Pollack, H., Sweterlitsch, P.: The effect of competitive pitching on the shoulders and elbows of preadolescent baseball players. Pediatrics 49, 267 (1972)

    Google Scholar 

  55. Torg, J.S., Moyer, R.A.: Non-union of a stress fracture through the olecranon epiphyseal plate observed in an adolescent baseball pitcher. J. Bone Joint Surg. [Am] 59, 264 (1977)

    Google Scholar 

  56. Towne, L.C., Blazina, M.E., Cozen, L.N.: Fatigue fracture of the tarsal navicular. J. Bone Joint Surg. [Am] 52, 376 (1970)

    Google Scholar 

  57. Wilcox, J.R., Jr., Moniot, A.L., Green, J.P.: Bone scanning in the evaluation of exercise-related stress injuries. Radiology 123, 699 (1977)

    Google Scholar 

  58. Wilson, E.S., Katz, F.N.: Stress fractures. An analysis of 250 consecutive cases. Radiology 92, 481 (1969)

    Google Scholar 

  59. Wilson, J.N.: Watson-Jones' Fractures and Joint Injuries, pp. 1306–1311 5th edition, London: Churchill Livingstone 1977

    Google Scholar 

  60. Wiltse, L.L., Widell, E.H., Jr., Jackson, D.W.: Fatigue fracture: The basic lesion in isthmic spondylolisthesis. J. Bone Joint Surg. [Am] 57, 17 (1975)

    Google Scholar 

  61. Wolfgang, G.L.: Stress fracture of the femoral neck in a patient with open capital femoral epiphyses. A case report. J. Bone Joint Surg. [Am] 59, 680 (1977)

    Google Scholar 

  62. Wright, T.M., Hayes, W.C.: The fracture mechanics of fatigue crack propagation in compact bone. J. Biomed. Mater. Res. 7, 637 (1976)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Veterans Administration Hospital, Durham, North Carolina, USA

    Richard H. Daffner M.D.

  2. Department of, Duke University Medical Center, Durham, North Carolina, USA

    Richard H. Daffner M.D.

Authors
  1. Richard H. Daffner M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daffner, R.H. Stress fractures: Current concepts. Skeletal Radiol. 2, 221–229 (1978). https://doi.org/10.1007/BF00347398

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00347398

Key words

Search

Navigation