Time to Return to Athletic Participation Following Stress Fracture

NewsBot · Aug 4, 2016

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Expected Time to Return to Athletic Participation Following Stress Fracture in Division I Collegiate Athletes
Marissa Jamieson et al
Orthopaedic Journal of Sports Medicine July 2016 vol. 4 no. 7

Objectives: The objective of this study was to evaluate and determine the expected time to return to athletic participation in Division I collegiate Track and Field athletes.
Methods: All stress fractures diagnosed in athletes on a single Division I collegiate men?s and women?s track and field/ cross-country team were recorded over a 4-year period. Site and severity of the injury were recorded and graded based on the Kaeding-Miller Classification System for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with the site and severity grade of the injury. Time to return to athletic participation was also analyzed for gender differences.
Results: Fifty-seven stress fractures were diagnosed in 38 athletes over a 4-year period. Thirty-seven of these injuries occurred in women; twenty in men. Mean time to return to participation in women was 13.9 weeks and 11.2 weeks in men. There were 10 athletes who sustained recurrent or multiple stress fractures. Thirty-three stress fractures occurred in the tibia, and 10 occurred in the 2nd through 4th metatarsals. Three occurred in the 5th metatarsal, 6 in the tarsal bones (2 navicular), and 5 in the pelvis. Mean times to return to athletic activity based on site of injury and with extreme outliers removed were as follows: tibia- 13.3 weeks, 2nd through 4th metatarsals- 11.7 weeks, 5th metatarsal- 11.7 weeks, tarsals- 12.1 weeks, and pelvis- 13.0 weeks. There were 31 grade 2 stress fractures, 11 grade 3 stress fractures, and two grade 5 stress fractures that occurred bilaterally in the same patient. Mean times to return to athletic participation again with extreme outliers excluded were as follows: Grade 2- 12.3 weeks, Grade 3- 14.1 weeks, and Grade 5- 17 weeks. There were no Grade 4 (displaced) stress fractures diagnosed in this cohort of patients.
Conclusion: Stress injuries to bone occur frequently in track and field athletes. Based on data collected from review of all recorded stress fractures diagnosed in members of a single Division I collegiate men?s and women?s track and field team over a period of four seasons, the expected time to return to full unrestricted athletic participation following diagnosis of a stress fracture is 12 to 13 weeks for all injury sites. Greater severity of injury correlated with increased time to return to participation with small numbers in the Grade 5 (nonunion) category making determining expected time to return to activity difficult
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NewsBot · Dec 19, 2017

Expected Time to Return to Athletic Participation After Stress Fracture in Division I Collegiate Athletes
Timothy L. Miller, MD, Marissa Jamieson, MD, Sonsecharae Everson, ATC, ...
Sports Health: A Multidisciplinary Approach December 14, 2017

Background:
Few studies have documented expected time to return to athletic participation after stress fractures in elite athletes.

Hypothesis:
Time to return to athletic participation after stress fractures would vary by site and severity of stress fracture.

Study Design:
Retrospective cohort study.

Level of Evidence:
Level 3.

Methods:
All stress fractures diagnosed in a single Division I collegiate men’s and women’s track and field/cross-country team were recorded over a 3-year period. Site and severity of injury were graded based on Kaeding-Miller classification system for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with patient sex and site and severity grade of injury.

Results:
Fifty-seven stress fractures were diagnosed in 38 athletes (mean age, 20.48 years; range, 18-23 years). Ten athletes sustained recurrent or multiple stress fractures. Thirty-seven injuries occurred in women and 20 in men. Thirty-three stress fractures occurred in the tibia, 10 occurred in the second through fourth metatarsals, 3 occurred in the fifth metatarsal, 6 in the tarsal bones (2 navicular), 2 in the femur, and 5 in the pelvis. There were 31 grade II stress fractures, 11 grade III stress fractures, and 2 grade V stress fractures (in the same patient). Mean time to return to unrestricted sport participation was 12.9 ± 5.2 weeks (range, 6-27 weeks). No significant differences in time to return were noted based on injury location or whether stress fracture was grade II or III.

Conclusion:
The expected time to return to full unrestricted athletic participation after diagnosis of a stress fracture is 12 to 13 weeks for all injury sites.
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NewsBot · Nov 9, 2022

An Assessment of the Diagnosis, Treatment, and Outcomes of Lower Extremity Stress Fractures in Pediatric and Adolescent Populations
Matthew Gremillion,Armando Martinez,Ramesh Ghanta,Neritan Borici &Indranil Kushare
The Physician and Sportsmedicine 03 Nov 2022

Objectives
To present one of the first descriptive case series of pediatric and adolescent lower extremity stress injuries, their management and outcomes in athletes and non-athletes.

Methods
: IRB-approved retrospective study included patients under 18 years at a tertiary children’s hospital who were diagnosed with a lower extremity stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, & outcomes were collected. Descriptive statistical analysis was conducted.

Results
97 patients with stress injuries on clinical exam and on radiographs or MRI were included. Average age when diagnosed was 11.7 years (range 1.1-18 years) and the most common injuries were to the tibia (n=33, 28.4%) and the least common involved were the cuneiforms (n=4, 3.4%). Patients under the age of 14 were more likely to experience cuboid and calcaneal stress injuries (mean age 5.5 and 8.3 years respectively). 19 patients (19.6%) had high-risk stress fractures, with the average age of 14.9 years versus 11.6 for those with low risk (p-value=0.01) and return to activity time being 15 weeks compared to 10.5 (p-value=0.027). The most common forms of treatment were controlled ankle motion (CAM) walker boots (58.6%) and physical therapy (PT) (38.1%). Mean Lower Extremity Function Score of the patient population was 73.8, indicating no clinically important difference from full functionality.

Conclusion
Lower extremity stress injuries in this cohort were most seen in the tibia, although patients younger than 14 had a high number of cuboid and calcaneal stress injuries. Those with high-risk stress fractures were older and took longer to recover when compared to low-risk injuries. Treatment is commonly conservative, with CAM boots and PT being the most frequently utilized interventions and serving as a successful approach to treatment, with patients returning to activity at an average of 11.4 weeks, which is comparable to similar studies.
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