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May 22-24, 2013
Saltsjöbaden
Difficult stress fractures through
the ATPC lens
Courtesy of Dr Stuart Houston
Normal reference
2 year oldLeft leg postoperative Left leg after 3 years
Before we go all ‘negative’ on bone!!
1. Stress
fracture in the Jones’ position
• Percutaneous screw fixation?
• 6 weeks plaster cast?
Stress fracture in the
Jones’ position
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8 weeks vs 16 weeks /
44% non-union rate
• Avulsion – 59 days to get back to football training
• Type II fracture – better success rate with surgery (75% compared with 33%)
• About 80 days +/- 20 days to get back to sport
• 25% recurrence rate
• Surgical options? Aim for lateral compression?
Sport-specific Stress FracturesClassic cases…
Others include:
1. Insidious medial foot pain
2. Groin pain in a marathon runner
3. Anterior shin pain in a jumper
4. Base of 2nd MT in a dancer
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1. Navicular stress fractures1. Navicular stress fracture
• Can be a career-stopping injury
• 8 weeks non-weightbearing cast is best supported by the literature (Torg, Khan, Scott Burne)
• Very inconvenient treatment
• Worked well for Michael Jordan
• Results of weightbearing rest are poor
• Surgery data are not encouraging
Classic cases…
Others include:
1. Insidious medial foot pain
2. Groin pain in a marathon runner
3. Anterior shin pain in a jumper
4. Base of 2nd MT in a dancer
2. Femoral neck (tension side)
Femoral neck (tension side)
• Undisplaced; initial bed rest for 1 week, then gradual weightbearing
• Displaced; surgical fixation
Classic cases…
Others include:
1. Insidious medial foot pain
2. Groin pain in a marathon runner
3. Anterior shin pain in a jumper
4. Base of 2nd MT in a dancer
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3. Anterior
tibial cortexAnterior tibial cortex
Controversial at present (too few to do a nice large RCT)
Clinical practice includes:
• 6-8 weeks non-weightbearing on
crutches
• 6-8 weeks walking in AirCast boot
• Intramedullary screw fixation
Classic cases…
Others include:
1. Insidious medial foot pain
2. Groin pain in a marathon runner
3. Anterior shin pain in a jumper
4. Base of 2nd MT in a dancer
4. Base of 2nd MT
(Ballet)
Base of 2nd MT stress fracture
• Non-weightbearing for 2 weeks
• Partial weightbearing for 2 weeks
What about pars defect?
• Managed symptomatically today – no longer a ‘difficult’ stress fracture
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Summary table – key is to
think of itMEMORABLE QUOTES