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Stress Fractures in Athletes

Fredericson, Michael MD*; Jennings, Fabio MD*; Beaulieu, Christopher MD, PhD; Matheson, Gordon O. MD, PhD*

Topics in Magnetic Resonance Imaging: October 2006 - Volume 17 - Issue 5 - p 309-325
doi: 10.1097/RMR.0b013e3180421c8c
Original Articles

A stress fracture is a partial or complete bone fracture that results from repeated application of stress lower than the stress required to fracture the bone in a single loading. Otherwise healthy athletes, especially runners, sustain stress injuries or fractures. Prevention or early intervention is the preferable treatment. However, it is difficult to predict injury because runners vary with regard to biomechanical predisposition, training methods, and other factors such as diet, muscle strength, and flexibility.

Stress fractures account for 0.7% to 20% of all sports medicine clinic injuries. Track-and-field athletes have the highest incidence of stress fractures compared with other athletes. Stress fractures of the tibia, metatarsals, and fibula are the most frequently reported sites.

The sites of stress fractures vary from sport to sport (eg, among track athletes, stress fractures of the navicular, tibia, and metatarsal are common; in distance runners, it is the tibia and fibula; in dancers, the metatarsals). In the military, the calcaneus and metatarsals were the most commonly cited injuries, especially in new recruits, owing to the sudden increase in running and marching without adequate preparation. However, newer studies from the military show the incidence and distribution of stress fractures to be similar to those found in sports clinics.

Fractures of the upper extremities are relatively rare, although most studies have focused only on lower-extremity injuries. The ulna is the upper-extremity bone injured most frequently.

Imaging plays a key role in the diagnosis and management of stress injuries. Plain radiography is useful when positive, but generally has low sensitivity. Radionuclide bone scanning is highly sensitive, but lacks specificity and the ability to directly visualize fracture lines. In this article, we focus on magnetic resonance imaging, which provides highly sensitive and specific evaluation for bone marrow edema, periosteal reaction as well as detection of subtle fracture lines.

From the *Division of Sports Medicine, Department of Orthopaedic Surgery, and †Department of Radiology, Stanford University School of Medicine, Stanford, CA.

Reprints: Michael Fredericson, MD, Stanford University School of Medicine, R-107A, 300 Pasteur Dr, Stanford, CA 94305-5336 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.