Athletic stress fractures: part I. History, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment.

This 3-part article is a comprehensive review of the literature on athletically induced (fatigue) stress fractures. As typical signs and symptoms of stress fracture may differ slightly depending on the bone involved, physicians examining a fracture need to be aware of these subtle differences. Stress fractures are the result of excessive loading of bone. (Excessive loading is caused by muscle pull, fatigue loading, or both and may be exacerbated by anatomic risk factors, age, and sex. Loading leads to a metabolic response by osteoclasts and osteoblasts. This response, which normally helps bone heal, instead causes the stress fracture.) Stress fractures resolve with 6 to 8 weeks of rest and rehabilitation. Part 1 of this article focuses on the history, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment of stress fractures. Part 2 reviews the specifics of stress fractures involving the lower body--the lower extremities, pelvic girdle, and feet and ankles. Part 3 reviews the specifics of stress fractures involving the upper body-shoulder girdle and thoracic region, upper extremities, hands and wrists, and pars interarticularis--and includes a special section on the female athlete. (Parts 2 and 3 will appear in the next issue.)