A database of systematic reviews, including 13 randomized prevention trials, concluded that shock-absorbing insert use in footwear probably reduces the incidence of stress fractures in military personnel. A recent systematic review and meta-analysis of nine observational studies examined the association between serum 25 (OH)D levels and stress fractures in the military and concluded that low vitamin D levels may play a role in the development of stress fractures in military personnel and monitoring and ensuring sufficient serum 25 (OH)D levels may be beneficial for reducing the risk of stress fracture. The authors postulated that given the poor vitamin D status, intervention studies of vitamin D supplementation to lower serum parathyroid hormone levels and possibly to reduce the incidence of stress fractures are warranted. In a study of 179 Finnish military recruits aged 18 to 20 years, tall height, poor physical conditioning, low hip bone mineral content and density, and high serum parathyroid hormone level were risk factors for stress fractures. Military recruits have been extensively studied in regard to lower extremity stress fractures. In contrast, in comparison of runners with and without history of tibial stress fracture, no difference in ground reaction forces, bone density, or tibial bone geometric parameters was found between groups. Studies of female runners demonstrated greater loading rates in those with history of tibial stress fractures compared with those without injury. A narrower mediolateral tibial width was a risk factor for femoral, tibial, and foot stress fractures in a study of military recruits. The fracture site is the area of greatest stress, such as the origin of lower leg muscles along the medial tibia. The most common stress fractures occur in the tibia (23.6%), but also develop in the tarsal navicular (17.6%), metatarsals (16.2%), femur (6.6%), and pelvis (1.6%). Specifically, stress fracture incidence in runners approaches 16% of all injuries. Stress fractures in the lower extremity account for 80% to 90% of all stress fractures, representing 0.7% to 20% of all sports medicine injuries. Stress fractures in athletes vary by sports and are most common in the lower extremities. Malalignment and poor flexibility of the lower extremities (intrinsic factors) and inadequate footwear, changes in training surface, and increases in training intensity and duration without an adequate ramp-up period (extrinsic factors) can lead to stress fractures. Both extrinsic and intrinsic factors have been implicated in this imbalance between bone resorption and bone deposition. Adolescent, young adult, and premenopausal women athletes have a higher incidence of stress injuries to bone than men do. Stress fracture is the end result of a continuum of biologic responses to stress placed on bone. If this remodeling system does not keep pace with the force applied, stress reaction (micro fractures) and, finally, stress fracture can result.
Normal bone accommodates to stress through ongoing remodeling. Stress fractures are complete or partial bone fractures caused by the accumulation of microtrauma. Unspecified fracture of shaft of unspecified fibulaįracture of unspecified tarsal bone(s) of right footįracture of unspecified tarsal bone(s) of left footįracture of unspecified tarsal bone(s) of unspecified footįracture of unspecified metatarsal bone(s), right footįracture of unspecified metatarsal bone(s), left footįracture of unspecified metatarsal bone(s), unspecified foot Unspecified fracture of shaft of left fibula Unspecified fracture of shaft of right fibula Unspecified fracture of shaft of unspecified tibia Unspecified fracture of shaft of left tibia Unspecified fracture of shaft of right tibia Unspecified fracture of shaft of unspecified femur Unspecified fracture of left shaft of the femur Unspecified fracture of right shaft of the femur
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