Stress fractures

ABSTRACT Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

A study on risk factors inducing stress fractures in young Japanese long-distance runners -effects of training distance and intensity- / 体力科学

The purpose of this study was to examine the risk factors of stress fractures in terms of training distance and intensity in young male Japanese high school long-distance runners. Nine hundred and twenty-five runners from high schools, colleges, and work teams responded to our questionnaire. Our analysis of the questionnaire found that the onset rates of stress fractures in males were 25.0%, 40.2%, and 55.3% in high school runners, collegiate runners, and work team runners, respectively, suggesting that young Japanese long-distance runners are more likely to suffer from stress fractures than European and American runners. Stress fractures occurred in male high school and collegiate runners after training that had increased running distance (24.7% and 33.1%, respectively) or running intensity (17.0% and 9.6%), or both increased running distance and increased running intensity (29.8% and 34.6%), suggesting that an increase in running distance at moderate intensity might be a major risk factor in stress fractures in young male long-distance runners. Data from college and work team runners that ran all three years of high school show that stress fractures are most likely to occur in May of the high school freshman year. These results suggested a need to reconsider training programs for freshmen to prevent stress fractures in young runners.

Isokinetic ankle muscle strength is reduced in recreational runners with medial tibial stress syndrome and is not associated with pain

Abstract Aim: The purpose of this study was to investigate the strength and ratios of the plantar flexors and ankle dorsiflexors in recreational runners with medial tibial stress syndrome and to assess the association between muscle strength and the level of pain in this population. Methods: Two groups (control and medial tibial stress syndrome) of eighteen runners each participated in this cross-sectional study. Isokinetic dynamometry was used to evaluate muscle strength, and for the analysis, the normalized isokinetic peak torque controlled by gender was used. Results: The medial tibial stress syndrome group showed lower normalized isokinetic peak torque in the dorsiflexors in the concentric (p = 0.008) eccentric (p = 0.011) contraction, as well as a lower plantar flexor, normalized isokinetic peak torque in the concentric (p = 0.001) and eccentric (p = 0.02) when compared to the control group. However, there was no difference in the normalized isokinetic peak torque ratio representative of the stance (p = 0.62) and swing phase (p = 0.16), and the level of pain was not correlated with the strength concentric (p = 0.32) and eccentric (p = 0.621) of plantar flexors, nor to the concentric (p = 0.21) and eccentric of dorsiflexors (p = 0.54). Conclusion: Recreational runners with MTSS showed decreased muscle strength in the sagittal plane of the ankle, no correlation with the level of pain, and no changing the ratio between plantar flexors and dorsiflexors.

The Role of Magnetic Resonance in the Diagnosis of Chronic Exertional Compartment Syndrome / O papel da ressonância magnética no diagnóstico da síndrome compartimental crônica do exercício

Abstract Chronic compartment syndrome is a common and often underdiagnosed exercise-induced condition, accounting on average for a quarter of cases of chronic exertional pain in the leg, second only to the fracture/tibial stress syndrome spectrum. It traditionally occurs in young runner athletes, although more recent studies have demonstrated a considerable prevalence in low-performance practitioners of physical activity, even in middle-aged or elderly patients. The list of differential diagnoses is extensive, and sometimes it is difficult to distinguish them only by the clinical data, and subsidiary examinations are required. The diagnosis is classically made by the clinical picture, by exclusion of the differential diagnoses, and through the measurement of the intracompartmental pressure. Although needle manometry is considered the gold standard in the diagnosis, its use is not universally accepted, since there are some important limitations, apart from the restricted availability of the needle equipment in Brazil. New protocols of manometry have recently been proposed to overcome the deficiency of the traditional ones, and some of them recommend the systematic use of magnetic resonance imaging (MRI) in the exclusion of differential diagnoses. The use of post-effort liquid-sensitive MRI sequences is a good noninvasive option instead of needle manometry in the diagnosis of chronic compartment syndrome, since the increase in post-exercise signal intensity is statistically significant when compared with manometry pressure values in asymptomatic patients and in those with the syndrome; hence, the test can be used in the diagnostic criteria. The definitive treatment is fasciotomy, although there are less effective alternatives.

Resumo A síndrome compartimental crônica é uma condição comum e frequentemente subdiagnosticada, induzida pelo exercício, que corresponde em média a um quarto dos casos de dor crônica na perna relacionada ao exercício, e que perde em frequência apenas para o espectro fratura/reação ao estresse tibial. Tradicionalmente ocorre em jovens atletas corredores, embora estudos mais recentes tenham demonstrado uma prevalência considerável em praticantes de atividade física de baixo rendimento, mesmo em pacientes de meia-idade ou idosos. A lista de diagnósticos diferenciais é extensa, e por vezes é difícil fazer a distinção apenas pelos dados clínicos, sendo necessários exames subsidiários. Classicamente, o diagnóstico é feito pelo quadro clínico, pela exclusão dos diferenciais, e pela medida pressórica intracompartimental. Embora a manometria por agulha seja considerada o padrão-ouro no diagnóstico, seu uso não é universalmente aceito, visto que existem algumas limitações importantes, além da disponibilidade restrita do equipamento com agulha no Brasil. Recentemente, novos protocolos de manometria têm sido propostos a fim suplantar a deficiência dos tradicionais, com algum deles inclusive recomendando o uso sistemático da ressonância magnética (RM) na exclusão dos diagnósticos diferenciais. O uso de sequências de RM sensíveis a líquido pós-esforço é uma ótima opção não invasiva à manometria por agulha no diagnóstico da síndrome compartimental crônica, uma vez que o aumento da intensidade de sinal pós-exercício é estatisticamente relevante quando comparados os valores pressóricos de manometria em pacientes com a síndrome e assintomáticos; portanto, o exame pode ser usado no critério diagnóstico. O tratamento definitivo é a fasciotomia, embora existam alternativas menos eficazes.

Bilateral Femoral Neck Stress Fracture Presented with Unilateral Symptoms in a Shipman Laborer: A Case Report / 대한고관절학회지

Femoral neck stress fracture occured commonly in athlete and military recruit populations, some of them are bilateral. Bilateral femoral neck stress fracture that associated with other occupation is very uncommon. We report a bilateral femoral neck stress fracture case that presented with unilateral symptoms in a male shipman laborer. The patient was successfully treated conservatively. Stress fracture sometimes occur associated with an unexpected specific occupation. Consideration of bilateral involvement is highly important in managing stress fracture.

Vascular foramina of navicular bone: a morphometric study / 대한해부학회지

The navicular bone is supplied by more than one artery. The knowledge about the vascular foramina is important to understand the pathogenesis and management of navicular fractures. The objective of the present study is to analyze the morphology and morphometry of vascular foramina of dried human navicular bone in Indian population. The study was carried out by using 100 navicular bones (50 right and 50 left) collected from our institute and other medical institutes in and around Puducherry. The bones were macroscopically studied for vascular foramina with respect to its location, number, size, and shape. The data collected were statistically analyzed. The vascular foramina were present on dorsal, plantar, medial, and lateral surfaces of navicular bone. Kruskal-Wallis test followed by series of Mann-Whitney test for post hoc analysis showed the number of nutrient foramina observed on dorsal surface were significantly greater than those observed on the plantar (U=2,755, P=0.001), medial (U=43, P=0.001), and lateral (U=626.5, P=0.001) surfaces of the navicle. About 97.6% of foramina were circular and 2.5% were oval in appearance. About 96.7% of vascular foramina were <1 mm in size and 3.3% were ≥1 mm in size. Spearman's rank correlation coefficient done showed a strong, positive correlation between vascular foramina of <1 mm size and circular shape, which was statistically significant (r(s)=0.981, P=0.001). We believe the present study has provided additional information on the vascular foramina of navicular bone and useful to surgeons in foot surgeries.

Fractura de Toddler. Reporte de un caso y revisión de la literatura / Toddler's fracture, case report and review of literature

Resumen: Introducción: La sospecha del diagnóstico de una fractura de Toddler a menudo es complicada debido a una historia poco clara, a la falta de hallazgos específicos en la clínica y a la ausencia de cambios evidentes en las radiografías iniciales. Presentamos el caso de una infante de tres años y siete meses de edad con el antecedente de caída desde su propia altura con mecanismo de rotación del miembro pélvico izquierdo. La finalidad de este escrito es describir la etiología, patología, diagnóstico y el manejo terapéutico en este tipo de fracturas. Discusión: La historia clínica, la exploración física y el uso de estudios de imagenología ayudan a identificar las fracturas de Toddler, patología que debe ser conocida por médicos especialistas para su manejo ideal.

Abstract: Introduction: The suspected diagnosis of a Toddler's fracture can often be complicated by an unclear history, the lack of specific clinical findings and the absence of obvious changes in the initial radiographs. We present the case of an infant of 3 years and 7 months old with a history of falling from her own height with a rotation mechanism of the left pelvic limb. The purpose of this paper is to describe the etiopathology, diagnosis and therapeutic management of these fractures. Discussion: The clinical history, physical examination and the use of imaging studies help identify Toddler's fractures, pathology that must be known to medical specialists for an ideal treatment.

Aspectos clínicos de las fracturas por stress / Clinical features of stress fractures

Las fracturas de stress son el resultado de la reiteración de cargas mecánicas en ciclos de intensidad, duración y frecuencia variables que, aplicadas como estímulos únicos, no serían suficientes para provocarlas. En líneas generales, el mecanismo propuesto para la generación de las fracturas de stress por fatiga es un desborde de la capacidad reparatoria de las microfracturas provocadas por las cargas de un exigente entorno mecánico, que corre a cargo de la remodelación ósea. Inicialmente fueron reportadas en el personal militar (en especial reclutas durante el período de instrucción) y luego en deportistas de diversas disciplinas que implican correr y/o saltar. Siendo esta la población primariamente en riesgo, se identificaron numerosos factores adicionales. En esta revisión se expondrán solamente aquellos de naturaleza endocrinometabólica y biomecánica. El síntoma inicial más frecuente de las fracturas por fatiga es el dolor focal, y su frecuencia es alta en los miembros inferiores. Se presenta al final de la actividad física, para luego extenderse a todo su curso y, finalmente, afectar también la deambulación diaria. El examen físico típicamente denota hipersensibilidad o dolor localizado sobre el área del hueso afectado, que a veces puede estar tumefacta. El diagnóstico se basa en las imágenes; la resonancia magnética nuclear es a de mayor sensibilidad y especificidad y la que permite un diagnóstico temprano, lo que es importante para prevenir un potencial progreso de la lesión a una fractura completa, osteosíntesis retardada o no unión, y necrosis ósea. (AU)

Stress fractures are the result of repeated cyclical loading whose intensity, duration and frequency are variable. These loads, applied as single stimuli, would not be enough to produce them. Overall, the proposed mechanism that generates fatigue fractures is an overflow in repair capacity, which is normally run by bone remodeling. They were first reported in military population (especially recruits during the training period) and later in athletes of various disciplines that involve running and / or jumping. This is primarily the population at risk. Other factors have been identified, only endocrine, metabolic and biomechanical will be discussed. The most common initial symptom of fatigue fractures is focal pain and frequency is high in the lower limbs. They appear at the end of physical activity, then spread throughou their course, and ultimately affect the daily ambulation. Physical examination typically shows hypersensitivity or localized pain on the area of the affected bone, which can sometimes be swollen. Diagnosis is based on images. Nuclear magnetic resonance has the highest sensitivity and specificity and allows early diagnosis, what is essential to prevent a potential progression of injury to a complete fracture, delayed healing or nonunion and bone necrosis. (AU)

Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training / 대한고관절학회지

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.

Bilateral Femoral Neck Stress Fracture in Child: A Case Report / 대한고관절학회지

A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain.

Biomecánica de las fracturas por stress / Biomechanical features of stress fractures

Se define como estrés (stress) tanto la fuerza que una carga externa ejerce sobre un cuerpo sólido como la fuerza reactiva que acompaña a la primera (Ley de Newton), por unidad de área imaginaria transversal a su dirección. Las cargas internas reactivas inducen deformaciones proporcionales del cuerpo. La resistencia del cuerpo a deformarse se llama rigidez. La deformación puede resquebrajar el cuerpo y, eventualmente, producir una fractura por confluencia de trazos. La resistencia del cuerpo a separarse en fragmentos por esa causa se llama tenacidad. La resistencia del cuerpo a la fractura es proporcional al stress que puede soportar sin separarse en fragmentos por deformación (no hay fractura sin deformación y sin stress previo). El stress máximo que un cuerpo puede soportar sin fracturarse resulta de una combinación de ambas propiedades: rigidez y tenacidad, cada una con distintos determinantes biológicos. Una o varias deformaciones del cuerpo pueden provocarle resquebrajaduras sin fracturarlo. La acumulación de resquebrajaduras determina la "fatiga" del material constitutivo del cuerpo, que reduce su rigidez, tenacidad y resistencia a la fractura para la próxima ocasión ("fragilidad por fatiga"). En el caso de los huesos, en general, los términos stress y fatiga tienen las connotaciones amplias referidas, respecto de todas las fracturas posibles. La fatiga predispone a fracturas a cargas bajas, que se denominan (correctamente) "fracturas por fatiga" y también (incorrectamente) "fracturas por stress", para distinguirlas de las que ocurren corrientemente, sin resquebrajaduras previas al trauma, que se denominan (incorrectamente) "fracturas por fragilidad, o por insuficiencia". En realidad, todas las fracturas se producen por stress y por fragilidad o insuficiencia (en conjunto); pero la distinción grosera entre fracturas "por fatiga, o por stress", por un lado, y "por fragilidad" o "por insuficiencia", por otro, aceptando las amplias connotaciones referidas antes, tiene valor en la práctica clínica. Este artículo intenta explicar esas particularidades biomecánicas y describir las distintas condiciones que predisponen a las fracturas "por fatiga o por stress" en la clínica, distinguiéndolas de las fracturas "por fragilidad o por insuficiencia" (manteniendo estas denominaciones) y detallando las características de interés directo para su diagnóstico y tratamiento. (AU)

The term "stress" expresses the force exerted by an external load on a solid body and the accompanying, opposed force (Newton's Law), expressed per unit of an imaginary area perpendicular to the loading direction. The internal loads generated this way deform (strain) proportionally the body's structure. The resistance of the body to strain expresses its stiffness. Critical strain magnitudes may induce micro-fractures (microdamage), the confluence of which may fracture the body. The body's resistance to separation into fragments determines its toughness. Hence, the body's resistance to fracture is proportional to the stress the body can support (or give back) while it is not fractured by the loadinduced strain (no stress, no strain -> no fracture). Therefore, the maximal stress the body can stand prior to fracture is determined by a combination of both, its stiffness and its toughness; and each of those properties is differently determined biologically. One or more deformations of the body may induce some microdamage but not a fracture. Microdamage accumulation determines the fatigue of the material constitutive of the body and reduces body's toughness, leading to a "fatigue-induced fragility". In case of bones, in general, both stress and fatigue have the referred, wide connotations, regarding any kind of fractures. In particular, bone fatigue predisposes to low-stress fractures, which are named (correctly) "fatigue fractures" and also misnamed "stress fractures", to distinguish them from the current fractures that occur without any excess of microdamage, that are named (wrongly) "fragility" or "insufficiency" fractures. In fact, all fractures result from all stress and fragility or insufficiency as a whole; however, the gross distinction between "fatigue or stress fractures", on one side, and "fragility or insufficiency fractures", on the other, accepting the wide connotations of the corresponding terminology, is relevant to clinical practice. This article aims to explain the above biomechanical features and describe the different instances that predispose to "fatigue or stress fractures" in clinical practice, as a different entity from "insufficiency or fragility fractures" (maintaining this nomenclature), and describe their relevant features to their diagnosis and therapy. (AU)

Proximal Tibia Stress Fracture Caused by Primary Degenerative Knee Osteoarthritis with Varus Deformity / 대한정형외과학회잡지

Stress fractures of the tibia are relatively common in military and young people. However, stress fracture of the proximal tibia is rare in elderly patients, but has been reported in association with osteoporosis, Paget disease, rheumatoid arthritis, pyrophosphate arthropathy, and knee deformities. We experienced a 65-year-old patient who did not have a chronic disease, with a stress fracture with primary degenerative knee osteoarthritis with varus deformity, which occurred at the proximal tibia, and we report on this unusual case with a literature review.

Bilateral Stress Fracture at the Inferior Pole of Patella in a Juvenile Athlete / 대한정형외과학회잡지

Patellar fractures in children occur rarely in approximately 1% of all pediatric fractures and 57% of these are osteochondral or cartilaginous avulsion fractures, a type of sleeve fracture. They may be missed in diagnosis due to small bony fragment on simple radiographs, and they always occur ipsilaterally; however, only a few cases of bilateral patellar fracture of the inferior pole have been reported. We experienced an 11 year-old patient an athlete, who suffered repetitive minor trauma, with a stress fracture, which occurred at the inferior pole of the patella bilaterally, and we report on this unusual case with a literature review.

Trapezoid Stress Fracture in a Weight Lifter / 대한정형외과학회잡지

Trapezoid fracture is a rare condition and especially, isolated trapezoid fracture is most rare condition of carpal bone fracture. And principle of treatment has not yet been established. Most of trapezoid fractures can be treated using cast but displaced fracture or fracture combined with other carpal bone fractures may require operative treatment. There have been reports about case of conservative treatment in trapezoid stress fracture but no report about case of operative management. We treated a trapezoid stress fracture in a weight lifting athlete by operative treatment and report the results with literature review.

Multiple Stress Fractures Related to Low-dose Adefovir Dipivoxil Treatment in a Patient with Chronic Hepatitis B: A Case Report

Stress fractures typically result from repeated abnormal mechanical loading to the bones. In particular, multiple stress fractures may occur in patients with systemic disease, such as rheumatoid arthritis, osteoporosis, or osteoarthritis. Adefovir dipivoxil (ADV), a nucleotide analogue of adenosine monophosphate, very rarely causes severe hypophosphatemia when using a low dosage of 10 mg daily for treatment of chronic hepatitis B. To the best of our knowledge, in English literature, this is the first report of multiple stress fractures in a chronic hepatitis B patient who has been treated with a low dosage of ADV. We think it is important to consider that use of ADV in a patient with chronic hepatitis B could be a risk factor for stress fractures.

Complications of Scarf Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications. MATERIALS AND METHODS: We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared. RESULTS: There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed. CONCLUSION: To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.

Stress Fracture of the Patella in a Child / 대한정형외과학회잡지

Stress fracture usually occurs in physically active individuals as a result of repetitive strenuous muscle and tendon forces acting on bones that have not adapted to such forces. To the best of our knowledge, the literature contains few reports of stress fracture of the patella. We report herein on a case of a nine-year-old female who developed a stress fracture in the patella after running.

Finite element analysis and fracture resistance testing of a new intraradicular post

OBJECTIVES: The objective of the present study was to evaluate a prefabricated intraradicular threaded pure titanium post, designed and developed at the São José dos Campos School of Dentistry - UNESP, Brazil. This new post was designed to minimize stresses observed with prefabricated post systems and to improve cost-benefits. MATERIAL AND METHODS: Fracture resistance testing of the post/core/root complex, fracture analysis by microscopy and stress analysis by the finite element method were used for post evaluation. The following four prefabricated metal post systems were analyzed: group 1, experimental post; group 2, modification of the experimental post; group 3, Flexi Post, and group 4, Para Post. For the analysis of fracture resistance, 40 bovine teeth were randomly assigned to the four groups (n=10) and used for the fabrication of test specimens simulating the situation in the mouth. The test specimens were subjected to compressive strength testing until fracture in an EMIC universal testing machine. After fracture of the test specimens, their roots were sectioned and analyzed by microscopy. For the finite element method, specimens of the fracture resistance test were simulated by computer modeling to determine the stress distribution pattern in the post systems studied. RESULTS: The fracture test presented the following averages and standard deviation: G1 (45.63±8.77), G2 (49.98±7.08), G3 (43.84±5.52), G4 (47.61±7.23). Stress was homogenously distributed along the body of the intraradicular post in group 1, whereas high stress concentrations in certain regions were observed in the other groups. These stress concentrations in the body of the post induced the same stress concentration in root dentin. CONCLUSIONS: The experimental post (original and modified versions) presented similar fracture resistance and better results in the stress analysis when compared with the commercial post systems tested (08/2008-PA/CEP).

Lesiones deportivas en niños y adolescentes / Pediatric and adolescent sports injuries

El aumento en la actividad deportiva de niños y adolescentes ha derivado en un aumento de las lesiones esqueléticas atribuidas a la actividad física. El aparato locomotor infantil presenta particularidades que hacen que los patrones de lesión difieran a lo que ocurre en los adultos. Se producen lesiones agudas y de sobrecarga que se presentan en edades y sitios específicos. Debido a la alta frecuencia de aparición de ellas, es necesario que los médicos que atienden niños estén familiarizados con los cuadros más frecuentes. En este artículo se revisan los aspectos más importantes de las principales lesiones deportivas en niños y adolescentes resumiendo las principales consideraciones diagnósticas, terapéuticas y pronósticas.

The increase in sport activity of children and adolescents has led to an increase in skeletal lesions attributed to physical activity. The children’s musculoskeletal system presents particularities that make injury patterns defer to those that occur in adults. Acute and overluse injuries are produced, which occur in specific locations and ages. Due to the high frequency of their occurrence, it is necessary that physicians who treat children are familiar with the most frequent conditions. In this article the most important aspects of major sports injuries in children and adolescents are reviewed by summarizing the main diagnostic, therapeutic and prognostic considerations.

Tension Band Plating for a Stress Fracture of the Anterior Tibial Cortex in a Basketball Player: A Case Report

Stress fractures of the anterior tibial cortex are prone to complete fracture because these stress fractures occur on the tension side of the bone. Recently, surgical treatments are preferred in high-performance athletes requiring rapid return to sports. We report our experience of a case in which stress fracture of the anterior tibial cortex was treated using anterior tension band plating in a male athlete and successful bony union and rapid return to sports were achieved.