Robertson Greg A J, Wood Alexander M
Greg A J Robertson, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA, United Kingdom.
World J Orthop. 2017 Mar 18;8(3):242-255. doi: 10.5312/wjo.v8.i3.242.
Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by "high" and "low" risk. "Low risk" stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. "High risk" stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting.
运动中的应力性骨折正变得越来越常见，占所有运动损伤的10%。此类损伤约90%位于下肢。本文旨在确定运动员下肢应力性骨折的最佳管理方法，以提高恢复率并缩短重返运动的时间。这种情况的治疗计划因损伤部位而异。然而，应力性骨折仍明显分为“高”风险和“低”风险。“低风险”应力性骨折是指骨折扩展、延迟愈合或不愈合概率较低的骨折，因此通过休息和限制运动即可可靠地进行处理。这些包括胫骨干后内侧、跖骨干、腓骨远端、股骨颈内侧、股骨干和跟骨的应力性骨折。相比之下，“高风险”应力性骨折的骨折扩展、移位、延迟愈合和不愈合发生率更高，因此需要立即停止活动，并转诊至骨科，以评估是否需要手术干预。这些包括胫骨干前侧、第五跖骨基底、内踝、股骨颈外侧、舟骨和拇趾籽骨的应力性骨折。为了确定管理这些损伤的最佳方法，我们展示并回顾了指导运动员应力性骨折治疗的现有证据。据此，我们注意到某些高风险应力性骨折的手术管理在缩短重返运动时间和提高恢复率方面的作用有所增加。在此之后，针对运动员常见应力性骨折类型的管理提供了关键建议。还给出了五个病例报告，以说明以运动为重点的下肢应力性骨折治疗在临床中的应用。
