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Sports injuries are common in children and adolescents. Typical musculoskeletal disorders include overuse injuries such as stress fractures and apophyseal avulsions. Gymnastics has one of the highest injury rates of all girls' sports. Intensive gymnastics can cause chronic spine and wrist trauma. Prevention of sport injuries should be a priority for parents, coaches and children themselves. Protection (helmet, padding) is mandatory for some activities. Proper education and preparation are necessary for all sports activities.

Objective: The aim of this paper is to give an overview on the scientific information related to stress fracture risk factors., Methods: We searched the Medline and Embase databases using the keywords stress fracture, risk factors and bone microarchitecture. Only French and English articles were included and 52 were chosen because they corresponded to literary reviews, prospective and retrospective studies concerning individuals who participate in athletics, in military recruits or civil., Results: Stress factures are common injuries in individuals who participate in athletics, in military recruits. Stress fractures of the lower extremity most commonly involve the tibia. A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading. To prevent stress fractures, an appreciation of their risk factors is required. Risk factors include intrinsic risk factors such as female gender, amenorrhea, lower bone density, inadequate muscle function and biomechanical features as well as extrinsic risk factors such as overtraining program, inadequate equipment and the energetic nutrition deficit. The coexistence of different risk factors makes so difficult the isolation of etiologic variables, Conclusion: Several risk factors have been comprehensively assessed in numerous studies. Hence, to date, there is still no general screening tool available to identify individuals at risk. Bone texture analysis seems to offer new prospects in the identification of stress fracture susceptibility.

Objective: The aim of this work was to review the literature for the place of extensive rehabilitation for athletes with stress fractures., Method: We searched the Medline and Embase databases using the keywords stress fracture, sports, rehabilitation, management and treatment. Only French and English articles were included, and articles about bone physiology, animal models, and spine and chest localisations were excluded. From 468 scientific articles, 62 were chosen because they corresponded to literary reviews or to therapeutic evaluations., Results: Treatment of stress fracture is justified according to risk factors, stress-fracture complications, the precocity of diagnosis, the therapeutic method and when the athlete needs to return to the sport. The most common treatment is discontinuing the sport, followed by rest. The progressive resumption of sport is rarely described but must take into account mechanical constraints that can be controlled by the use of shoes adapted to a supple ground. Some treatments such as immobilization by pneumatic splint surgery or use of electric fields are controversial., Conclusion: Extensive treatment of stress fractures is mainly dedicated to high-level athletes who need to regain previous physical capacities as soon as possible.

Purpose: Spontaneous fractures (stress and bone insufficiency fractures) are well described in young healthy patients; however, few studies were conducted in the elderly., Methods: A 30-month prospective clinical and epidemiological survey including elderly patients from long-term nursing homes (LTNH) of the Société de Gérontologie de l'Est (70 centers; 11,495 elderly patients in total) was conducted., Results: Sixty-seven spontaneous fractures were encountered in 30 LTNH (3,052 elderly patients) (five stress fractures of the foot, 62 bone insufficiency fractures). The mean age of bedridden patients was 85 +/- 7 years. The prevalence of spontaneous fractures (calculated from the number of patients admitted consecutively in LTNHs) was 0.34% in the whole population (11,495 beds). When the calculation was based on LTNH reports of spontaneous fractures (3,052 elderly patients), the prevalence reached 1.3%. Fractures of long bones were common in elderly patients and included 15 fractures of the femoral neck, 14 fractures of either the tibia or fibula, 13 fractures of the femoral shaft, and 11 fractures of the humerus. Fractures of the femoral shaft were associated with the highest mortality: seven out of 13 patients died versus two out of 15 patients with regard to fractures of the femoral neck (P < 0.05)., Conclusion: Bone insufficiency fractures have not the same course in young healthy patients as those in elderly nursing home patients: they more often concern long bones and their prognosis is worse. Means of prevention still have to be defined.

Objectives: Fractures of the sacrum due to bone deficiency are not extremely uncommon although this cause has been overlooked for many years. We performed a meta-analysis of reported cases in order to determine the specific characteristics., Method: The characteristics of 493 cases of sacral fractures reported in the literature and those of 15 personal cases were studied., Results: Most of the fractures occurred in women over 60 years of age. No trauma was identified in two-thirds of the cases. Clinical expression was not specific (back pain, sciatica, pelvic pain). Standard x-ray showed a fracture of the obturator frame in 38.8% of the cases but no direct or indirect signs of sacral fracture were seen in more than two-thirds of the cases. Tc99m scintigraphy had excellent sensitivity; a characteristic hyperfixation pattern for ming an "H" was observed but only in 42.7% of the cases. Computed tomography had similar sensitivity and confirmed the diagnosis in doubtful cases. Treatment was usually bed rest until satisfactory pain relief. Of particular importance were neurological complications although they were exceptional. Several factors favoring sacral fracture were found, mainly osteoporosis and prior radiotherapy of the pelvis., Conclusion: Clinicians should be aware of this type of fracture which still remains largely over-looked in geriatric care units.