Fatigue fracture (fatigue fracture) occurs when a bone is overloaded and forms gradually. Symptoms are gradual and are often not noticed as signs of a fracture. A fatigue fracture takes several weeks or even months to heal completely.
What is a fatigue fracture?
Plaster casts are almost always used for fractures. 6 weeks is usually required to wear it. A fatigue fracture is a fracture that is caused by stress over a long period of time. Unlike an acute fracture, in which an excessive force is applied to the bone once and causes it to break, in a fatigue fracture the bone is subjected to repeated and sustained loading. This causes it to become brittle over time, resulting in minute cracks in the structure. There are two types of fatigue fracture. Insufficiency fracture occurs when the bones were already pre-damaged by a disease. Stress fracture is the fracture of healthy bones, which are broken only by the permanent overload. Very often the fatigue fracture occurs in athletes, such as in running, but also in certain professions in which repetitive powerful movements are required, the fatigue fracture occurs. Usually, one or more metatarsals, a cervical or thoracic vertebra, or the ribs are affected. (See also: sports injuries)
Causes
Fatigue fracture results from constant overloading of a bone. The force applied is not strong enough to cause the bone to break immediately. But the repetitive stress causes the bone tissue to change. So-called microfractures occur, which are tiny fissures and cracks in the bone mass. Since the body always tries to counteract any disturbances that occur, it forms more bone substance, which is then broken down again. Due to the constant building and breaking down, the bone becomes more porous and eventually breaks. The overloading of the bone is favored by misalignments of the feet, by too little muscle mass or also by too thin bones. Fatigue fracture of the foot usually occurs during running (Jones fracture or marching fracture). Vertebrae and ribs can occur during severe coughing fits that occur over a long period of time (cough fracture). Fatigue fracture of thoracic or cervical vertebrae is also called Schipper’s disease because it is caused by repetitive shoveling movements.
Symptoms, complaints, and signs
Fatigue fracture results from overuse, usually from hard physical work or sports. It is often a fractured area, less often a smooth fracture. Therefore, the fatigue fracture often has very different symptoms than the classic fracture, which is usually caused by an event such as a fall or blow. Thus, the fatigue fracture is usually not directly recognized as such by the patient. It manifests itself in moderate to severe pain. The affected region can no longer be loaded properly and loses functionality. If a load is nevertheless applied, it is associated with severe pain. Most often, the fatigue fracture occurs in the foot or hand. In these areas, comparatively small bones are exposed to a very high load. The area affected by the fatigue fracture not only hurts very much, but also swells visibly. The surrounding tissue is supplied with more blood and therefore often feels warm or even hot. In rare cases, the fatigue fracture is also accompanied by a hematoma. This hematoma develops internally, but comes to the surface of the skin after a few days. The clearest indication besides the pain is a partial to almost complete immobility and lack of performance of the affected body part. A displacement of the bones as in the classic fracture is observed less frequently.
Diagnosis and course
A fatigue fracture is initially noticeable by a mild pain. With continued exertion, the pain increases, but at rest it subsides. Swelling and redness of the skin often occur at the fracture site. The symptoms are often not perceived as a fracture, as they develop gradually. In contrast to the acute fracture, the bone remains functional for a long time in the fatigue fracture. Only after a longer period of time does it become impossible for the affected person to put weight on the bone.At this point, even the pain at rest no longer subsides, but is permanently noticeable. The diagnosis is made using imaging techniques, such as X-ray, magnetic resonance imaging (MRI), scintigraphy or computer tomography (CT). This allows the doctor to easily see the fine cracks in the bone tissue and the fracture itself. However, the diagnosis is usually made quite late, as the symptoms are often not interpreted correctly and the doctor is only consulted after a long period of suffering.
When should you go to the doctor?
When increasing pain is noticed that cannot be attributed to any other cause, a doctor should be consulted. A fatigue fracture definitely requires medical evaluation and treatment. That is why it is best to consult a general practitioner at the first signs. At the latest, when swelling and redness of the skin appear, professional advice is needed. Other warning signs: Pain at rest and restrictions in the ability to move the affected limb. Anyone who notices these symptoms should consult a doctor. A fatigue fracture results from constant stress on the bones. People who do a lot of sports or physically strenuous work should therefore have regular check-ups and talk to their family doctor if they notice any of the warning signs mentioned. Other contacts are the orthopedist or the chiropractor, depending on the position and severity of the fracture. In case of acute symptoms, the nearest hospital should be visited. After initial treatment, physiotherapeutic measures are indicated. First, to promote recovery and second, to prevent recurrence of fatigue fractures.
Treatment and therapy
Treatment of a fatigue fracture is based on how far the damage to the bone has progressed and the location of the fracture. If an impending fatigue fracture is detected early, it is often sufficient to avoid the causative stress and to rest the body part. This allows the bone to recover and the bone tissue to regenerate. Furthermore, physiotherapeutic measures can support healing. If the fatigue fracture has already occurred, the bone is immobilized with a cast and pain-relieving medication is administered. If the fatigue fracture has not been recognized for a long time and the bone is very damaged, surgery may be necessary. There are various surgical procedures for this purpose. The bone can be strengthened with a nail inserted into the bone marrow. Screw fixation with metal plates from the outside is also used for a fatigue fracture. Finally, there is spongiosaplasty. This involves taking bone material from the pelvis and inserting it into the fracture site. Depending on the type of treatment, the bone can be carefully and very lightly loaded again after two to four weeks. However, in severe cases of a fatigue fracture, it can take up to six months before the bone is ready for use again.
Prevention
A fatigue fracture can be prevented by not permanently overloading the body. In sports, one should pay attention to the correct posture on the one hand, and on the other hand, take seriously any signals from the body that indicate overload. In the case of running, shock-absorbing shoes serve as a preventive measure. In the case of existing underlying diseases, such as osteoporosis, one should always keep the load on the musculoskeletal system low as a preventive measure against a fatigue fracture.
Aftercare
A fatigue fracture requires a lot of aftercare and rebuilding. Formerly called “marching fractures,” fatigue fractures were once a commonly observed phenomenon in marching soldiers. Today, bones are more likely to fatigue in athletically active people, but usually without an external cause that would justify a fracture. Acute treatment of the fatigue fracture is followed by a decompression phase. In this, the patient’s demineralized bone is treated by physiotherapy. Through physiotherapy, the bones receive impulses so that they can maintain the bone synthesis capacity. After a fatigue fracture, the patient cannot put weight on the bone until there is sufficient stability in the bone structure. If pain occurs during loading, the bone must be relieved and strengthened again. One of the most important points of aftercare is to keep the training load lower than before. Training sessions must be adjusted to prevent a new fatigue fracture from occurring. The aftercare phase can sometimes take a very long time.If no training overloads are present, an analysis of the causes of the fatigue fracture must be performed during follow-up care. Overload zones can be identified and compensated for by means of gait analysis or equipment training. Special footwear or orthopedic inserts may be considered. A change in certain movement patterns can also provide additional relief. In addition, taking calcium, vitamin D supplements or bisphosphonates can additionally strengthen the bones.
What you can do yourself
Since the fatigue fracture is usually caused by overloading, patients can also do some things in everyday life as part of self-help to achieve an uncomplicated and rapid healing of the fracture, as well as to prevent a recurrence. In the acute phase, the main thing here is to follow the doctor’s rules of conduct exactly and to consistently take care of the affected area. In the foot area, this can be the use of walking aids, for example. Any pain or swelling can also be easily treated by elevating the affected body part, cooling it or using painkilling trauma ointments. The patient’s assistance is also required in the regeneration phase following the acute state of the fatigue fracture. The reloading, for example of an affected foot, is best increased gradually to avoid a new fracture. In addition, it is important to strengthen the muscles of the affected region, as muscles act like a protective corset around the musculoskeletal system. In the foot area, movements that strengthen the small muscles of the foot and also increase mobility in this area are useful here. All of these measures, which are best discussed with the attending physician beforehand, serve to restore full function and minimize the risk of re-injury.
