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Millions of dollars are lost each year to the US military in medical discharges from injuries sustained in the initial training of recruits. Most medical discharges in recruits are related to musculoskeletal overuse injuries, including stress fractures. Any strategies that can reduce injury rates are also likely to reduce rates of medical discharge. This study evaluated the Army Physical Readiness Training (PRT) program which was established to provide a method of physical fitness training that would reduce the number of preventable injuries. We conducted a retrospective study to evaluate the number of lower extremity stress fractures that were diagnosed in the 6 months prior to and 6 months following the implementation of the PRT program. Electronic medical records were queried for specific diagnoses of stress fractures to the pelvis, femoral neck, femoral shaft, tibia, fibula, tarsals and metatarsals. The observed number of diagnoses in each time period were compared using the χ² method. Decrease was shown not only in the overall occurrence of stress fractures, but specifically in the occurrence of stress fractures of the femoral neck, femoral shaft, and tarsals. Our study was able to show a correlation between the PRT program and a decrease in the observed occurrence of lower extremity stress fractures.

Background: Presentation of own experiences, observations and results of treatment of patients with stress fractures treated in the Department of Paediatric Orthopaedics. The authors present an algorithm of diagnosing and treatment of stress fractures., Material and Methods: Over the period 1998 - 2010, 38 patients were hospitalised (40 fractures) with the final diagnosis of stress fracture. Personal patients' data, case histories and management preceding the diagnosis of the disease, diagnostic and therapeutic methods, as well as the results of treatment were collected on the basis of medical documentation. Standard diagnostic procedure consisted of: clinical and radiological examination, laboratory tests as well as computed tomography (CT). In 11 cases, the procedure included also scintigraphy and in two children MRI scan was performed., Results: Complete healing of fractures was finally achieved in all patients, Conclusions: In case of suspected stress fracture, it is necessary to perform a series of radiograms, which should present the picture of bone rebuilding and incorporation of the periosteal callus. If plain radiograph is inconclusive we should consider MRI , CT or scintigraphy scan. The results of laboratory tests should not show any abnormalities. In case of confirmed stress fracture nonweight-bearing of the affected extremity is recommended as well as introducing of close clinical-radiological monitoring. The results of MRI examination should be interpreted very cautiously, be cause it can be misleading. The observation strategy (“wait and see”) should be implemented. However, the lack of the regression of pain sensation, bone rebuilding features and incorporation of periosteal callus or the appearance of visible bone destruction (lysis) should raise questions and present an indication for taking biopsy of the laesion.

Stress reactions and stress fractures in the lower extremities occur frequently in military and athletic populations. As the clinical symptoms of stress fracture may mimic other less severe musculoskeletal injuries, the diagnosis of stress fracture can often be delayed. The following article reviews the characteristics, advantages and disadvantages of the various imaging tools available to detect stress fracture of the lower limbs in order to clarify their utility when diagnosing this condition. Plain radiography, the primary imaging tool for diagnosing suspected stress injuries, may not detect stress fracture injury until fracture healing is well underway. In some cases of suspected stress fracture, this delay in diagnosis can lead to catastrophic fracture and surgical intervention. Bone scintigraphy has long been recommended for the diagnosis of stress fracture, claiming that skeletal scintigraphy is 100% sensitive for the detection of stress fracture. However, there is a potential for a false negative examination and findings might be nonspecific as tumours or infections may mimic stress injury. In addition, bone scintigraphy involves ionizing radiation and it should not be used whenever there is an alternative. Computed tomography (CT) provides exquisitely fine osseous detail, but should be reserved only for specific indications because it also involves ionizing radiation. Magnetic resonance (MR) imaging, which is noninvasive, has no ionizing radiation, is more rapidly performed than bone scintigraphy, and should be the method of choice for stress fracture diagnosis whenever it is available. However, using MR imaging demands an experienced diagnostician in order to decrease reported false-positive injuries. The ultrasonography technique, which is being used increasingly in the evaluation of the musculoskeletal system has recently been shown to have some potential in the diagnosis of stress fracture; however, currently the imaging modalities are insufficient. The peripheral quantitative CT (pQCT) device, which has been developed to specifically assess skeletal status of the extremities, provides data on bone geometry, strength and density. However, the pQCT needs further evaluation prior to being considered for use in diagnosis stress changes in bone. This article reviews the utility of each of the imaging modalities currently available to detect stress fracture injuries of the lower extremities, as well as other utilization factors, which include exposure to ionizing radiation, the ability to detect early- and late-stage reactions in the bone and surrounding soft tissues, and the ability to differentiate between different types of bone lesions.

There have been no studies devoted exclusively to stress fractures in competitive athletes with immature skeletal systems so far. The object of this case series was to describe special features of stress fractures in athletes with immature skeletal systems, with special reference to sport-specific strain, diagnosis and treatment results. The study population was made up of 19 children and adolescents with a total of 21 stress fractures. The average observation period was 4.83 years [standard deviation (SD) 2.69] and the average age at diagnosis, 14.04 years (SD 4.7). The lower extremity was affected in most of our cases. In adolescent athletes, endurance sports appear to lead preferentially to stress fractures in the region of the metatarsal bones, while sports requiring sudden stops at high speed appear to increase the risk of fractures in the region of the tibial diaphysis (P=0.0322). Most (20 of 21) of the fractures in this study were treated conservatively with refraining from athletic activity and reduction of stress/weight-bearing for an average of 6.73 weeks (SD 2.91). In five cases the extremity was in addition immobilized in a plaster cast for 5.32 weeks (SD 2.21). Complete healing was achieved in 14 cases. In seven cases, however, the treatment did not lead to a satisfactory outcome. Most of the patients whose symptoms persisted over a long period had fractures in the tibia and were engaged in sports requiring frequent sudden stops. Our data suggest that stress fractures in athletes, whose skeletal systems are still immature, lead to a clinical picture that does not always culminate in a good outcome of treatment. We therefore recommend a thorough and early diagnostic investigation (including MRI) and consistent treatment whenever a patient's history and clinical picture give any indication that a stress fracture might be present.