Different localizations of a stress fracture | Stress fracture

Different localizations of a stress fracture

If the knee joint is subjected to excessive stress over a longer period of time, the bony structures involved may be fractured under stress. In the knee joint, the thigh (femur), fibula and tibia are connected to each other. For example, the head of the fibula (fibula head) can fracture (break).

This is the head of the fibula, which is palpated on the outside of the lower knee. Since it is very narrow and delicate, it is very susceptible to stress fractures, especially when the knee is rotated. The result is gradual pain and increasing restriction of movement in the knee joint.

A stress fracture in the area of the knee can also occur directly at the kneecap (patella). Particularly in sports that put a lot of stress on the knee, such as gymnastics or dancing, the kneecap can gradually tear further, leading to a stress fracture. Such a stress fracture then manifests itself especially during knee movements by pain, swelling or redness in the area of the knee.

The patients concerned find it increasingly difficult to climb stairs, in particular, because the knee is under particular strain. In most cases, a stress fracture of the knee can be easily treated by immobilizing the knee. However, it is important in this phase to refrain completely from strenuous sport, as otherwise serious consequential damage can occur.

In the knee area, this would be associated with chronic movement restrictions and severe pain. The doctor’s recommendations regarding protection and gradual increase of the load must therefore be observed. The foot is exposed to heavy loads, especially when running, because it carries the entire body weight.

For this reason, stress fractures are particularly common. In the context of regular long marching and hiking routes, stress fractures occur particularly frequently in the area of the metatarsus, near the second toe. The result is severe pain, which becomes even more intense when walking or running.

The foot is also swollen and can take on a reddish discoloration. A stress fracture of the foot can be reliably diagnosed by means of a skeletal scintigraphy or an MRI, but the diagnosis often cannot be confirmed by X-ray. After diagnosis, the stress fracture should be relieved and immobilized as a matter of urgency.If the fracture ends are in the area of the metatarsus, adequate immobilization can be achieved by wearing a special forefoot relief shoe.

Decongestant measures such as lymph node drainage and kinesio-taping can be carried out as a support. A fatigue fracture of the foot usually heals completely within four to six weeks. However, the gradual build-up of stress should always be carried out in consultation with the doctor.

Permanent overloading can also lead to a stress fracture in the shin bone (tibia). The most common cause is excessive jogging, as well as changed training habits, weight changes or a too hard surface. A typical symptom is pain, which initially occurs gradually and only under stress.

In the course of time the pain increases and then also occurs at rest. Swelling and redness in the area of the shin bone are also possible. The therapy usually consists of immobilizing the respective leg for several weeks.

A plaster cast must often be applied for this purpose. In more complicated cases, surgical treatment can also be performed. In this case, the bone ends are reconnected with screws or metal plates.

In the case of surgical therapy, healing is usually much faster and the load-bearing capacity can be increased more quickly. The fibula tends to form a stress fracture in two areas in particular; 1) in the area of the knee, i.e. at the head of the fibula, or 2) in the lower area of the fibula, which forms the outer ankle. Only very rarely does the fibula fracture in the middle, then more likely due to a “normal” fracture resulting from acute trauma.

In the area of the external ankle (malleolus lateralis), a stress fracture can occur, especially in the case of sustained overloading during long marches or when jogging. This is manifested by recurrent swelling in the area of the ankle as well as reddening and painful walking. The pain becomes worse under stress, especially when jumping or jogging.

Particularly frequent bending not only puts strain on the ligaments and muscles, but can also lead to stress fractures in the lower calf or outer ankle. Suspension of training and immobilization of the ankle are absolutely necessary to achieve regeneration of the bone and prevent the complaints from progressing. Here too, conservative or surgical therapy is possible; the choice depends on the extent and complexity of the stress fracture.

A stress fracture of the calcaneus is often very painful. The most common cause is excessive strain from running or walking, so that some sports such as hiking or jogging are particularly predisposed. It is almost impossible for those affected to step on the heel, so that they assume a changed gait.

Furthermore, the heel often shows swelling and redness. In principle, after diagnosis by means of an imaging procedure, conservative or surgical treatment can be performed. An uncomplicated stress fracture can usually be treated with a simple plaster cast.

Ibuprofen or paracetamol have an analgesic effect. The heel must now be protected for about 14 days to allow the bone time to regenerate. If the fracture is displaced (dislocated) or if there is involvement of the ankle joint, surgical intervention is necessary.

The ends of the fracture are brought back into a straight position and then fixed together with wires or plates. Depending on the type of material, it may have to be removed again a few months later. Even after an operation, the foot is subsequently plastered in order to ensure immobilization.

A stress fracture of the bones involved in the pelvic ring is in principle rather rare. The reason for this is that the pelvis does not carry the same weight as the foot or leg and the bones are much more stable. But even here, stress fractures in particularly vulnerable areas are conceivable due to strenuous sports such as jogging, dancing or gymnastics.

For example, jogging can lead to a fracture of the sacrum. In this case, too, it is absolutely necessary to refrain from the activity that causes the fracture, usually sport. Since absolute immobilization of the pelvis can only be achieved by bed rest, compromises have to be made here, but abstaining from sports is absolutely necessary. In some more complicated cases, the fracture must be surgically stabilized using plates and screws.