Stress fracture fixation
The treatment and surgery that is best for your stress fracture is dependent upon a number of factors, including your age, present health and level of activity, health history, the location of the fracture and any history with medications and other treatments. Stress fractures occur most commonly in athletes and typically affect the feet and legs.
A stress fracture is an injury that can inhibit training and performance if not treated properly. If you are concerned that you may have a stress fracture, it is important to seek medical attention early on to treat it and not make the condition worse. To diagnose your injury, your doctor will ask questions regarding your symptoms and level of activity, and then perform a physical exam. To find the specific location of the injury, one of the following techniques will be used:
- X-ray (radiograph) – Depending on how long you have had symptoms, an X-ray will be performed to determine the location of the injury. However, this test typically can show the fracture only after you have had it for seven days or more. It is done by sending electromagnetic radiation through the site of the injury. The bone will then absorb the radiation, allowing the doctors to see the fracture.
- Computer tomography scan (CT or CAT scan) – This test uses the same technology as the X-ray and combines it with computer technology to generate a more detailed three-dimensional image. This test is used rarely, but it is sometimes helpful in determining the extent of a stress fracture.
- Magnetic resonance imaging (MRI) – This test offers a more detailed image, allowing doctors to see a stress fracture two to three days after it appears. During the test, you will be lying in a tube. The tube will then rotate around the body and send magnetic radio waves through the bones, causing them to vibrate. This resonance is then displayed on an image which can show the bone as well as the soft tissue and blood vessels.
- Bone scan – This test involves using radioactive dye to see the bone area. It is injected through an IV line a few hours before the test. Then, the bone shows up white on an image.
In most cases, with rest a stress fracture can heal on its own. Because the injury occurs through overuse, which means it gradually worsens over a long period of time, the bone is typically not at risk of becoming displaced, as is the case with many trauma incidents. By avoiding use of the affected limb, the bone usually can heal itself over a period of time. In some cases, you may be able to continue fitness activity in the pool where the risk of impact is lower. With more severe cases, a cast or brace will be used to limit the mobility of the affected area and reduce the amount of weight placed on the hurt bone.
In some cases where the injury has become more severe, a stress fracture may be at risk of displacement and require surgery. The goal of most stress fracture surgeries is to prevent the bone from moving and to repair the injury caused by overuse. The majority of surgically treated stress fractures involve one of the following techniques:
- Metal plates and screws – In the event that the injury occurs in the joint area, such as a stress fracture in the femoral head, or upper thighbone, metal plates and screws will be used to repair the injury and reduce the risk of additional complications from displacement. This is done by reconnecting any displaced bones, then attaching a plate to the area of the displacement and using screws to hold it in place.
- Pins – In some cases pins may be used to hold the bone in place. These generally are used when the area of the fracture is not located along a major joint and the pins can be used to straighten the bone and keep it securely in place.
The majority of the research around stress fractures focuses on prevention. Because this injury occurs from overuse of a particular part of the body, especially among runners and athletes who do high- impact sports, finding preventive measures can help avoid taking an athlete away from the sport by preventing the injury in the first place, or stopping it from recurring.
Researchers Finestone and Milgrom studied the use of a combination of semirigid orthosis and soft orthosis used in the boots of military recruits during their stint at boot camp. The research was to try to determine if these orthoses would help reduce the occurrence of stress fractures and thereby be an effective preventive measure for other athletes as well.
The findings showed significantly higher comfort levels in the group using semirigid orthosis and soft orthosis. Of those, the group with the soft orthosis had more comfort overall. The insoles were found to significantly reduce the shock absorbed by the bones and therefore also reduce the number of stress fractures. Other researchers, Gillespie and Grant, reviewed these findings in four other trials and found similar results. While these results were all very positive, there is still research to be done about how to best protect the bones and body from this common injury.
As research on prevention is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs stress fracture surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.