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> Disorders > Injury or Poisoning > Stress Fractures

Stress Fractures

Stress fractures are overuse injuries caused by repetitive stress on the bones, often seen in athletes and physically active individuals.
These tiny cracks in the bone can be difficult to diagnose and require proper treatment to prevent further damage.
PubCompare.ai's AI-powered platform can help streamline your research workflow by identifying the best protocols and treatments for stress fractures from the latest literature, pre-prints, and patents.
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Most cited protocols related to «Stress Fractures»

1
Fatigue Fracture Surface Analysis
Fracture surface analysis was performed by Macek [34 (link),35 ,39 (link)] using an optical 3D test stand that facilitated the acquisition of data sets at a high depth of focus [45 (link),46 (link)]. The failed specimens were observed under 10× magnification using an Alicona G4 InfiniteFocus (Alicona Imaging GmbH, Graz, Austria) as described previously [47 (link)]. Due to the restricted field of view, nine rows by seven columns were stitched together to map the entire fracture area. Each individual micrograph had a vertical resolution of 79.3 nm with a lateral resolution of 3.91 µm. The abovementioned measurement device, exhibited in the upper part of Figure 4, was operated via IF-MeasureSuite software (version 5.1, Alicona Imaging GmbH, Graz, Austria), while the measurement of surface features was conducted using MountainsMap software (version 7.4, Digital Surf, Besançon, France). Alicona (*.al3d) files were imported into the surface metrology software MountainsMap and resampled into height maps at a resolution automatically determined by the software. Surfaces were analysed in relative coordinates (X, Y, and Z axes) with the Z axis in heights from the lowest point by default. No additional filters were used. Fatigue fracture surfaces were measured for local (propagation and rupture) profiles and for total areas. Figure 5 shows examples of the propagation areas and main surface parameters as well as rupture areas and main texture parameters observed in the experiments for the three metal alloys studied.
To check the fracture surface dependency on the fatigue loading history, selected parameters, reported among others in Figure 5, were measured and calculated. Table 4 defines the used parameters according to the ISO 25178 standard.
It is known that the microrelief of fatigue fracture surface is determined by the material properties and the stress intensity factor in the tip of the initial crack; therefore, the parameters of the microrelief depend on the stress amplitude and the fatigue crack length. When testing ductile materials, the height of the fracture profile usually increases with increasing crack length, and at the stage of the fatigue crack propagation, three zones with different roughness are found: the initial zone with a predominant shear microrelief; the zone with striation microrelief; and the zone of accelerated crack growth, in which striations and dimples are observed. With an increase in the stress amplitude, the size of the zones changes, the zone with striations decreases and the zone of rupture grows. When testing brittle or quasi-brittle materials, the height of the fracture profile often decreases with increasing crack length as a result of the formation of facets of cleavage or intergranular fracture [48 (link),49 (link),50 (link),51 (link)]. Overall, there were obvious differences in topography for propagation or rupture, particularly the coarser areas. Ra (Equation (1)) averages all peaks and valleys of the roughness profile and then neutralizes the few outlying points, so that the extreme points have no significant impact on the final results. Sa, as expressed in Equation (2), represents the mean height of the surface, according to the ISO 25178 standard. Their functionality was analysed later in the study.
The Abbott–Firestone curves (see centre of Figure 4) provide important information on the surface properties in a systematic and quantitative approach. In the example chart, the Abbott–Firestone curve shows the cumulative height distribution histogram. The horizontal axis represents the measured scale in depth of the surface, and the vertical axis depicts percentage of the whole population of data. The shape of the curve is distilled into several of the surface roughness parameters [52 ]. The distributions of the surface highlights that the crack initiation region had a smoother surface without asperities.
Ra = 1lr∫0lr|z(x)|dx
Sa = 1A∬A|z(x,y)|dxdy
Macek W., Branco R., Szala M., Marciniak Z., Ulewicz R., Sczygiol N, & Kardasz P. (2020). Profile and Areal Surface Parameters for Fatigue Fracture Characterisation. Materials, 13(17), 3691.
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Publication 2020
Alloys Cytokinesis Epistropheus Fatigue Fingers Fracture, Bone Medical Devices Metals Microtubule-Associated Proteins Stress Fractures Surface Properties Vision Tests
2
Systematic Review of Stress and Physical Activity
A search was conducted in Web of Science, SPORTDiscus and PubMed for relevant literature. The search terms utilized were “stress”, “exercise”, and “physical activity”. This yielded a large number of returns. Consequently, the search was narrowed by selecting options in each database. When possible, articles were eliminated for irrelevant fields (e.g., engineering, chemical science, etc), unoriginal data (e.g., review articles, corrections, editorials, magazine articles), non-human subjects, and text not reported in the English language. Starting with Web of Science, titles and abstracts of articles were reviewed by one of the authors (MSK) for relevance with date in descending order. To speed the search, titles containing “stress test”, “oxidative stress”, “stress fracture”, “stress incontinence”, or “urinary stress” were automatically disqualified. Abstracts were also reviewed for relevance and scanned to make sure that PA was the outcome variable of interest and stress variables were the predictors. Case-control studies that investigated PA in stressed populations were retained. After this process was completed for the first database, the inspection of results for SPORTDiscus ensued. Articles were further eliminated if they were duplicated in Web of Science. This resulted in a very small collection of additional articles. With the additional fact that the initial results from PubMed were very large, the search date range was shortened to the years 2000–2012. These returns were searched for relevance as before. Finally, all article reference lists were examined for pertinent reports. The last search for articles via database was in July 2012 (see Fig. 1).
Stults-Kolehmainen M.A, & Sinha R. (2014). The Effects of Stress on Physical Activity and Exercise. Sports medicine (Auckland, N.Z.), 44(1), 81-121.
Publication 2013
Exercise Tests Oxidative Stress Population Group Stress Fractures Urinary Stress Incontinence Urine
3
Cyclic Loading of Mouse Forelimbs to Induce Stress Fractures

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Publication 2010
Debility Forelimb Fracture, Bone Mice, House Stress Fractures Ulna
4
Epidemiology and Impact of NBA Jones Fractures
Given the public nature of these data, no institutional review board approval was necessary for this study. The study group was composed of all NBA athletes who had sustained an acute Jones fracture during competition in an NBA game over a time period between the 1994-1995 and 2012-2013 seasons. Subjects were identified using a comprehensive online injury database (http://www.prosportstransactions.com). Results were cross-referenced with team press releases, online injury reports, and player profiles to confirm diagnosis. This method has been validated in multiple studies.2 (link),3 ,7 (link),8 ,14 (link),16 (link) Effort was made to differentiate between stress fractures of the fifth metatarsal and acute Jones fractures. Access to an official NBA-controlled injury database was not available.
Thirty-seven players with acute Jones fractures were identified. Of these, 26 players with appropriate complete statistical performance data were included in the study. Return to play was defined as returning to at least 1 game of equal level of competition the year after injury. A 1-to-1 matched control group was selected based on “similarity scores” provided by a comprehensive online database (http://www.basketballreference.com). This score identifies players whose careers are most similar according to performance data and seasons of play. Regarding position, backcourt players were designated as “guards,” while frontcourt players were classified as “forwards.” Controls were additionally selected according to position, and all efforts were made to select controls without a significant injury history.
The index year was defined as the season in which the player sustained the Jones fracture. The index year for controls was matched to the age of the matched-subject at the time of injury. Study parameters included the season before and after injury, as well as averaged data over 3 seasons before and after injury, if available. Method of treatment and instances of recurrence and/or reoperation were recorded. Demographic data, including height, weight, and body mass index (BMI), were collected. Performance data were recorded before and after injury and included games missed, minutes per game, assists per 36 minutes played, rebounds per 36 minutes played, steals per 36 minutes played, blocks per 36 minutes played, and points per game. Statistics were evaluated on a per minute basis to help control for an athlete’s playing time.
Additionally, NBA player efficiency rating (PER) data were collected on all subjects and controls. PER is a novel statistical method that involves the summation of a player’s positive statistical contributions and then subtracting negative measures.9 Yearly, a PER of 15 is designated to represent an average NBA player. PER is a comprehensive statistic that accounts for variables such as a player’s playing time as well as their team’s pace and style and allows for standardized comparisons between players. It has been previously used as a variable in similar studies.1 (link),2 (link),20 (link)As no previous studies have investigated the variability in PER with regard to Jones fractures, this pilot study used all available injuries to establish the PER means and variances for this injury to allow for future studies. Unfortunately, no sample size estimate was performed. Descriptive statistics were performed to describe the cohorts and their demographics. Univariate analysis was performed to compare the cohorts and the outcomes of the subjects (continuous variables were evaluated using Student t tests and categorical data were evaluated using the Fisher exact test). Additionally, multivariate regression analysis was performed to identify which factors were associated with performance (as measured by PER) after the injury while controlling for age, height, BMI, seasons in the NBA, minutes played per game prior to the injury, and PER 1 year prior to the injury as predictor variables. All statistical analyses were performed using SPSS version 19.0 software (IBM Corp), and significance level was set at P < 0.05.
Begly J.P., Guss M., Ramme A.J., Karia R, & Meislin R.J. (2015). Return to Play and Performance After Jones Fracture in National Basketball Association Athletes. Sports Health, 8(4), 342-346.
Publication 2015
Athletes Cardiac Arrest Diagnosis Ethics Committees, Research Fracture, Bone Index, Body Mass Injuries Metatarsal Bones Recurrence Second Look Surgery Stress Fractures Student Therapeutics
5
Factors Influencing Injury Recovery in Novice Runners
The DANO-RUN study was a 1-year prospective follow-up study aiming at characterizing risk factors for injury in novice runners. Present paper describes a sub-analysis of the injured novice runners included in the DANO-RUN study. The procedure for enrolment, inclusion and exclusion criteria and main purpose of the DANO-RUN study has been presented elsewhere[5] –[7] . All participants provided informed written consent prior to inclusion and the research was conducted in accordance with the Helsinki Declaration. The Scientific committee, Central Denmark Region evaluated the protocol (M-20110114) but waived the request for approval because observational studies, according to the Danish law, do not require an ethical approval. The Danish Data Protection Agency approved the study.
A novice runner was defined as a person who had not been running on a regular basis for the past year. The cut-off to define a regular basis was set at 10 km of the total running distance in all training sessions during the past year prior to inclusion. If a total of 10 km was exceeded a person was ineligible for inclusion. For instance, a person was included if he/she had been running a total of 3 times 2 kilometers in the past year and excluded if he/she had been running 5 times 4 kilometers. A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running (distance, duration, pace, or frequency) for at least 1 week. This definition of injury was a modified version of the injury definition used in the studies on novice runners [3] (link), [8] (link), [9] (link). The date of injury occurrence was based on the anamnesis where the injured runner was asked to recall the date at which the symptoms started.
Prior to the study, no consensus-based definition of time to recovery was found. The authors defined recovery from injury as no pain in the affected anatomical location following two consecutive running sessions of at least 500 meters. The time to recovery was calculated as time in days from injury occurrence to complete recovery. In the case a participant was free of pain in activities of daily living but refused to run in order to evaluate on their symptoms, the recovery was defined as the day they were free of pain.
All injured participants attended a clinical examination in case of injury. At the examination, the participant was examined and diagnosed, preferably no later than 1 week after the participant had requested an examination. In most examinations (more than 80%), at least two physiotherapists (of four assisting in the study) diagnosed the injured participant based on a consensus agreement. A standardized examination procedure was used in each of the following anatomical locations: foot/ankle, lower leg, knee, thigh, hip and back. Furthermore, guidelines for diagnostic criteria were used to classify the injuries into specific diagnoses/types of injuries. These non-validated guidelines were developed by the DANO-RUN research group prior to the study (Material S1). At each examination, the injured runner was asked if they believed the injury was caused by running. If they said “yes” the injury was included in the analysis, while the injury was excluded if they said “no”. If they said “no” the injury was not registered in the database and it is, therefore, not possible to present details about these types of injuries.
In case the physiotherapist was unable to diagnose the injured runner at the clinical examination or the participant did not recover as expected after being diagnosed, an additional examination including diagnostic imaging (most often MRI) was performed. Such examination was provided in approximately 25% of all injuries and was always offered if the physiotherapist at the first examination diagnosed injuries like medial meniscal injury, osteoarthritis or stress fractures. The additional examination and diagnostic imaging were performed at the Division of Sports Traumatology at Aarhus University Hospital, Denmark. Based on the clinical examination(s), the diagnoses were registered for all injuries occurring from inclusion in the study and in the following 1-year period. In cases where the examiners (Physiotherapist and medical doctors) were in doubt and the diagnostic imaging was negative, the injury was classified as unknown.
After the clinical examination, all injured participants were followed prospectively and contacted by phone or mail once every 2 to 3 weeks to follow-up on injury status. In case the participants recovered from injury, questions regarding the use of medication (yes/no), treatment assistance from health professional (yes/no), surgical treatment (yes/no) and missed days from work (number) were asked. In addition, participants had to report their motivation to start running again after having had an injury and this information was then dichotomized into: 1) Less motivated or not at all motivated or 2) motivated or very motivated. If a participant completely recovered from injury and sustained an additional running-related injury afterwards, the participant had to attend a clinical examination again. The possibility of clinical examinations was stopped after the participants had been included in the DANO-RUN study for 1-year. The follow-up on injured participants were stopped February 2013, eighteen months after the first participants were enrolled at a baseline investigation and 7 months after the last participants completed follow-up.
Descriptive data were presented as counts and percentage dichotomous or categorical data. Data on time to recovery were presented as medians and the range between minimum and maximum because data on injury were considered non-parametric evaluated by histograms and quartile-quartile plots. Contra wise, data on the log scale was normally distributed. Therefore, the student's t-test was used to test if time to recovery (days) was different between those motivated to take up running again after having had an injury compared with those being less motivated. The Wilcoxon rank sum test was used to test if the time to recovery was different across gender and across age (dichotomized into less than or above 40 years because masters runners typically are defined as persons above 40 and face subtle differences in injury rate and location[10] (link)) because the data were not normally distributed on original scale or on the log scale. All analyses were performed using STATA/SE version 12.1. A result was considered significant at p<0.05.
Nielsen R.O., Rønnow L., Rasmussen S, & Lind M. (2014). A Prospective Study on Time to Recovery in 254 Injured Novice Runners. PLoS ONE, 9(6), e99877.
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Publication 2014
A-factor (Streptomyces) Ankle AURKB protein, human Degenerative Arthritides Diagnosis Face factor A Foot Health Personnel Immunologic Memory Injuries Knee Leg Lower Extremity Meniscus, Medial Mental Recall Motivation Operative Surgical Procedures Pain Pain-Free Pharmaceutical Preparations Physical Examination Physical Therapist Physicians Sex Characteristics Stress Fractures Thigh

Most recents protocols related to «Stress Fractures»

1
Midfoot Wedge Distraction Arthrodesis
Patients were included in this study if: (1) diagnosis was based on clinical evaluation and radiologic findings on weight-bearing AP and lateral views; (2) had at least 5 years postoperative follow-up; (3) the conservative treatment was ineffective for more than 6 months; (4) the surgical method is TNC arthrodesis; and (5) they had only unilateral limb surgery. Patients were excluded from the study if: (1) had a history of Kohler disease; (2) a previous traumatic or stress fracture of the navicular; (3) had rheumatoid arthritis; and (4) incomplete radiographic data or missing follow-up data.
In total, 26 patients underwent operative treatment for the dysfunction and pain caused by MWD between January 2015 and August 2017. This study reviewed 15 patients who had undergone TNC arthrodesis at the mid-term follow-up and met the inclusion criteria. The patient enrollment is described in Fig. 1. This study was approved by the institutional review board. The participants used in this study provided informed consent. Two senior doctors performed all operative procedures in line with standardized protocols.

This figure shows the number of patients included in this study

Bai W., Li Y., Shen G., Zhang H., Li X, & Zhu Y. (2023). Talonavicular-cuneiform arthrodesis for the treatment of Müller-Weiss: mid-term results of 15 cases after 5 years. BMC Musculoskeletal Disorders, 24, 178.
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Publication 2023
Arthrodesis Conservative Treatment Diagnosis Ethics Committees, Research Koehler Disease Navicular Bone of Foot Operative Surgical Procedures Pain Patients Physicians Rheumatoid Arthritis Stress Fractures X-Rays, Diagnostic
2
Radiographic Assessment of Reverse Shoulder Arthroplasty
Preoperative and postoperative radiographs were reviewed and graded by 2 attending orthopedic surgeons. In cases of rotator cuff tear arthropathy, disease severity was graded using the classification by Hamada.12 Preoperative CT scans and MRIs were corrected to the scapular plane assessed when available. Glenoid version was measured at the level of the coracoid tip on axial series referencing Friedman’s line. Postoperative radiographs were examined to determine the presence of glenoid and humeral component loosening or subsidence as well as glenoid notching as defined by Sirveaux.24 (link) Humeral radiolucencies were graded using the zone system analogous to that of Gruen et al for THA.17 (link) When present, acromial or scapular spine stress fractures were classified using the Levy classification.15 (link)
Chamberlain A.M., Aleem A.W., Sefko J.A., Steger-May K, & Keener J.D. (2023). Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; medium-term results. JSES International, 7(2), 277-284.
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Publication 2023
Acromion Humerus Magnetic Resonance Imaging Orthopedic Surgeons Rotator Cuff Tear Arthropathy Scapula Stress Fractures Vertebral Column X-Ray Computed Tomography X-Rays, Diagnostic
3
Acromial Stress Fracture Outcomes Analysis
Paired t-tests were used to determine if outcomes significantly changed between pre- and postoperative. Spearman correlation coefficients assessed the association of (a) demographics, surgical/clinical characteristics, and complications with postoperative outcomes and change in outcomes, and (b) demographics, surgical/clinical characteristics, and preoperative outcomes with postoperative satisfaction. Postoperative outcome scores were compared for shoulders with and without sustained acromial stress fractures by Wilcoxon’s test. Sample sizes vary across pre- and postoperative variables; analyses used available data from each shoulder. The analysis includes bilateral data from five patients. There was no adjustment for the lack of independence of data from the same patient due to the limited sample size. A P-value of < .05 was considered significant. All statistical analyses were performed using SAS software, version 9.4 of the SAS System for Windows (SAS Institute Inc., Cary, NC, USA).
Chamberlain A.M., Aleem A.W., Sefko J.A., Steger-May K, & Keener J.D. (2023). Clinical outcomes after reverse shoulder arthroplasty in patients 60 years old and younger; medium-term results. JSES International, 7(2), 277-284.
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Publication 2023
Acromion Operative Surgical Procedures Patients Postoperative Complications Satisfaction Shoulder Stress Fractures
4
Cross-Sectional Study of Menstrual Dysfunction and Nutrition in Female Soccer Players
This study was a cross-sectional study and was approved by the International University of
Health and Welfare (21-Io-18).
Between February and March 2022, the first author requested research cooperation from the
women’s soccer team via email, telephone, or verbally. The purpose of the study was
explained to the team representatives. As an ethical consideration, an overview of the study
was given at the beginning of the questionnaire, and the first question asked whether the
participants gave their “consent to participate in this study”. Informed consent was
obtained from the minors, and consent to participate was obtained from parents.Participation
in this study was voluntary. The purpose and objectives of the study were explained in
writing and on video, and the URL of the Google form was distributed to the participants to
answer the questions. Of the 137 respondents, 115 were included in the analysis. The
exclusion criteria were as follows: (1) those who had not reached menarche, (2) those who
were not registered with the Japan Football Association, and (3) those who were under
12 years old and over 29 years old.
There were four main sections of questions: basic information, nutrition (related to lack
of available energy), menstrual dysfunction, and history of disabilities (For example,
fatigue fractures related to osteoporosis). For the osteoporosis question, the participants
were asked to indicate when and what type of injury they had suffered to determine if they
had a fatigue fracture. The nutrition questions included “Do you eat three meals a day?”
(yes/no), “Do you usually snack?” (yes/no), “What do you snack on?” (free response), “Do you
know your daily calorie intake?” (yes/no), and “Do you want to lose or gain weight?”
(yes/no).
Questions related to menstruation included “What was your age at menarche?”, “Have you ever
had amenorrhea?” (yes/no), “Have you ever visited a hospital for treatment?” (yes/no), “Have
you ever found menstruation bothersome?” (yes/no), “Have you ever felt a change in
performance due to menstruation?” (yes/no), “Have you taken painkillers at least once a
month?” (yes/no), and “Do you take low-dose pills? ” (yes/no).
According to the league classification to which they belonged, the participants were
grouped into the Japan Women’s League (hereafter referred to as “top league”), university
leagues, regional leagues (eight regional leagues), and prefectural leagues, in descending
order of competition level. In addition, to clarify the characteristics of players with
amenorrhea, they were divided into two groups according to whether they had amenorrhea, and
comparisons regarding menstruation were made.
Statistical analysis was conducted by tabulating each survey item and comparing them by
league category. One-way analysis of variance and Bonferroni subtests were used for age,
height, weight, and age at menarche, and χ2 tests were used for the survey items.
Differences due to amenorrhea were analyzed using an uncorrelated t-test and a χ2test.
Matsumoto C., Ishizaka M., Kubo A, & Itokazu M. (2023). Female athlete triad cross-sectional study of soccer players by level of competition. Journal of Physical Therapy Science, 35(3), 170-174.
Publication 2023
Analgesics Contraceptives, Oral Disabled Persons Feelings Hospital Administration Injuries Menarche Menstruation Osteoporosis Parent Snacks Stress Fractures Woman
5
Bone Mass Development in Young Athletes
The study was carried out on 181 young male volunteers during the period of reaching peak bone mass (20–23 years) in the spring of 2018. Taking into account their physical activity level, they were divided into two groups: control (n = 87) and trained (n = 94). The control group consisted of untrained students from the Faculty of Physical Education and Health in Biała Podlaska who regularly participated in practical classes included in the study curriculum for 3 years and declared that they did not perform regular physical activity outside of the physical education classes at university (5 h per week). Exclusion criteria were as follows: a recent leg injury/stress fracture, a history of musculoskeletal diseases, current smokers, chronic steroid treatment, taking any medications and dietary supplements less than 3 months before the study.
The trained group included men practicing different kinds of sports in local sports clubs, such as soccer (n = 44), wrestling (n = 22), handball (n = 13) and mixed martial arts (MMA, n = 15). Soccer players (representing 4th league soccer clubs) and handball players (representing 1st league handball clubs), as well as MMA fighters (at a collegiate level), were students from the Faculty of Physical Education and Health in Biała Podlaska, whereas the wrestlers (at a national level) were current or previous students from the Sports School in Radom. All these athletes declared long training experience (7.5 ± 2.5 years) and weekly training loads of 10–12 h.
All the participants provided their written, informed consent to take part in the study. The study was in compliance with the Helsinki Declaration. The protocol of the study was approved by the Local Ethics Committee at the University of Physical Education in Warsaw (no. SKE 01-24/2015).
Jówko E., Długołęcka B., Cieśliński I, & Kotowska J. (2023). Polymorphisms in Genes Encoding VDR, CALCR and Antioxidant Enzymes as Predictors of Bone Tissue Condition in Young, Healthy Men. International Journal of Molecular Sciences, 24(4), 3373.
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Publication 2023
Athletes Bone Density Dietary Supplements Faculty Leg Injuries Males Musculoskeletal Diseases Pharmaceutical Preparations Physical Education Regional Ethics Committees Steroids Stress Fractures Student Voluntary Workers

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