Stress Fractures - Hairline Fractures

In 1855 Briethaupt, a military doctor made the first documentation of stress fractures in soldiers, hence also known as "march fractures". Stress fractures occur as a result of depressed bone response to the ground-reaction forces that are usually dissipated during walking, running or jumping. Bones are capable of remodeling when exposed to normal strain and stress. Overuse or excessive loads are the predisposing factors for hairline fractures.

Causes of Stress Fractures

Intrinsic Reasons of Stress Fractures
Most of all stress fractures occur in the legs and foot as they are subjected to maximum weight bearing

• Foot Structure: Instability and inappropriate weight bearing due to high arched foot increases pressure on leg bones leading to fractures
• Bone density: Osteopenia and osteoporosis make the bones frail on account of the reduced mineral bone density
• Muscle system: Weaker muscles or reduced flexibility of muscles increase stress on related bones. Women are more prone to stress fractures as they have lesser bulk of muscle mass compared to men. Lesser muscle girth means low shock absorption
• Inadequate nutrition: Low intake of calcium and vitamin D. Abnormal eating habits like fasting, binge eating or use of laxatives
• Medical conditions: Hyperparathyroidism, Osteosarcoma
• Hormonal conditions: Oestrogen deficiency, menstrual dysfunction and amenorrhea
• Any coinciding injury can cause reverse compensation by overloading the bones and joints leading to stress fractures
• Adolescents : Developing bones in teenage is one of the risk factors

External Causes of Stress Fractures

• Aggressive training program: Rapid increase in duration and intensity of workouts
• Improper footwear: Shoes with faulty cushioning or worn-out shoes cause low shock absorbing capacity
• Training surface: Hard and uneven surfaces
• Medications : Long term use of steroids
• Cigarette smoking

Symptoms of Stress Fractures

• Pain at rest or pain increases with activity
• Pain at night
• Pain may be diffuse or spot tenderness
• Swelling

Stress fracture can be seen in an X-ray mostly after 6 weeks of onset of pain. An orthopedic surgeon might suggest CT scan or MRI to confirm diagnosis.

Related Activity/Sports	Sites of Stress Fracture
Marching	Metatarsal, calcaneus
Ballet dancing	Tibial shaft, metatarsal bone
Runners	Tibial shaft, patella, femur, sesamoid bones
Rowers	Rib-2nd to 10th
Tennis	Navicular injury
Volleyball	Interarticularis injury
Racquet Sports	Humerus
Gymnastics	Pars interarticularis, Ulna
Aerobics	Fibula
Basketball	Medial malleolus

Treatment of Hairline Fractures

• Rest is crucial during the healing period of 6-8 weeks
• Ice packs: Application of ice reduces acute pain and inflammation
• Medications: NSAID’s or analgesics as per the degree of pain
• Exercise: Non-weight bearing exercises like swimming for overall fitness
• Shoe Inserts: Walking crutches, braces or supportive orthotics are used
• Surgery: Rarely surgical repair is needed

Prevention of Stress Fractures

• Muscle strengthening and stretching exercises to increase flexibility
• Ensure a nutritious diet rich in vitamins and calcium
• Gradually increase sports activity or exercise
• Use of proper sports equipment and shoes