Fracturas de tibia por estrés y hallazgos patológicos asociados en reclutas
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Publicado:
abr 16, 2024
Palabras clave:
Fracturas por estrés, enfermedad asociada, tibia, reclutas
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Resumen
Introduction: Tibial stress fractures are a very common condition in military recruits. Our objective is to demonstrate that stress fractures are associated with other diseases.
Materials and Methods: 42 stress fractures in 34 patients were retrospectively evaluated. Every patient had recently joined the Argentine Army and consulted for painful symptoms in the tibia. A clinical and scintigraphic diagnosis of stress fracture was made. Patient data, associated diseases, and risk factors were documented. Inclusion criteria: recent incorporation, same training, age between 16 and 23 years. Trauma, simulators, tumoral pathology, and cases with negative scintigraphy were excluded.
Results: We studied 42 stress fractures in 34 patients, 14 were men and 20 were women. The average age was 20 years. There were no significant differences in the number of injuries regarding the affected limb. 64.7% had associated diseases, 73% in women and 27 % in men. Among the women with stress fractures, 80% had associated diseases, compared to 43% for men. Different diseases were found with lower limb varus and valgus imbalances. Varus was the most associated with fractures.
Conclusions: A high rate of associated diseases was found in patients with tibial stress fractures with a predominance of lower limb varus imbalances. Associated diseases were more likely to be found in women with stress fractures than in men.
Materials and Methods: 42 stress fractures in 34 patients were retrospectively evaluated. Every patient had recently joined the Argentine Army and consulted for painful symptoms in the tibia. A clinical and scintigraphic diagnosis of stress fracture was made. Patient data, associated diseases, and risk factors were documented. Inclusion criteria: recent incorporation, same training, age between 16 and 23 years. Trauma, simulators, tumoral pathology, and cases with negative scintigraphy were excluded.
Results: We studied 42 stress fractures in 34 patients, 14 were men and 20 were women. The average age was 20 years. There were no significant differences in the number of injuries regarding the affected limb. 64.7% had associated diseases, 73% in women and 27 % in men. Among the women with stress fractures, 80% had associated diseases, compared to 43% for men. Different diseases were found with lower limb varus and valgus imbalances. Varus was the most associated with fractures.
Conclusions: A high rate of associated diseases was found in patients with tibial stress fractures with a predominance of lower limb varus imbalances. Associated diseases were more likely to be found in women with stress fractures than in men.
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Coria, H. E., Fedún Rodríguez, E., García, D., Masaragian, H., Mizdraji, L., Perin, F., Rega, L., Sartorelli, D., & Veizaga Velasco, J. (2024). Fracturas de tibia por estrés y hallazgos patológicos asociados en reclutas. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(2), 143-149. https://doi.org/10.15417/issn.1852-7434.2024.89.2.1868
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Investigación Clínica
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Citas
1. Greeves JP, Beck B, Nindl BC, O’Leary TJ. Current risks factors and emerging biomarkers for bone stress injuries in military personnel. J Sci Med Sport 2023;26(Suppl 1):S14-S21. https://doi.org/10.1016/j.jsams.2023.04.006.S14-21
2. Devas MB. Stress fractures in athletes. Proc R Soc Med 1969;62(9):933-7. PMID: 5823819
3. Milgrom C, Zloczower E, Fleischmann C, Spitzer E, Landau R, Bader T, et al. Medial tibial stress fracture diagnosis and treatment guidelines. J Sci Med Sport 2021;24(6):526-30. https://doi.org/10.1016/j.jsams.2020.11.015
4. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician 2011;83(1):39-46. PMID: 21888126
5. Milgrom C, Giladi M, Stein M, Kashtan H, Margulies JY, Chisin R, et al. Stress fractures in military recruits. A prospective study showing an unusually high incidence. J Bone Joint Surg Br 1985;67(5):732-5. https://doi.org/10.1302/0301-620X.67B5.4055871
6. Brukner P, Bennell K. Stress fractures in female athletes. Sports Med 1997;24(6):419-29. https://doi.org/10.2165/00007256-199724060-00006
7. Gam A, Goldstein L, Karmon Y, Mintser I, Grotto I, Guri A, et al. Comparison of stress fractures of male and female recruits during basic training in the Israeli Anti-Aircraft Forces. Mil Med 2005;170(8):710-2. https://doi.org/10.7205/milmed.170.8.710
8. Franklyn M, Oakes B, Field B, Wells P, Morgan D. Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes. Am J Sports Med 2008;36(6):1179-89. https://doi.org/10.1177/0363546508314408
9. Popp KL, Hughes JM, Smock AJ, Novotny SA, Stovitz SD, Koehler SM, et al. Bone geometry, strength, and muscle size in runners with a history of stress fracture. Med Sci Sports Exerc 2009;41(12):2145-50. https://doi.org/10.1249/MSS.0b013e3181a9e772
10. Protzman RR, Griffis CG. Stress fractures in men and women undergoing military training. J Bone Joint Surg 1977;59(6):825-825. PMID: 908707
11. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: A one-year study of incidence as related to age, sex, and race. Mil Med 1983;148(8):666-7. https://doi.org/10.1093/milmed/148.8.666
12. Abbott A, Bird ML, Wild E, Brown SM, Stewart G, Mulcahey MK. Part I: epidemiology and risk factors for stress fractures in female athletes. Phys Sportsmed 2020;48(1):17-24. https://doi.org/10.1080/00913847.2019.1632158
13. Moran DS, Heled Y, Arbel Y, Israeli E, Finestone AS, Evans RK, et al. Dietary intake and stress fractures among elite male combat recruits. J Int Soc Sports Nutr 2012;9(1):6. https://doi.org/10.1186/1550-2783-9-6.2012
14. Griffin KL, Knight KB, Bass MA, Valliant MW. Predisposing risk factors for stress fractures in collegiate cross-country runners. J Strength Cond Res 2021;35(1):227-32. https://doi.org/10.1519/JSC.0000000000002408
15. Yong JR, Silder A, Montgomery KL, Fredericson M, Delp SL. Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures. J Biomech 2018;76:1-7. https://doi-org/10.1016/j.jbiomech.2018.05.017
16. Swissa A, Milgrom C, Giladi M, Kashtan H, Stein M, Margulies J, et al. The effect of pretraining sports activity on the incidence of stress fractures among military recruits. A prospective study. Clin Orthop Relat Res 1989:(245):256-60. PMID: 2787719
17. Armstrong DW, Rue JPH, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone 2004;35(3):806-16. https://doi.org/10.1016/j.bone.2004.05.014
18. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc 2013;21(3):556-63. https://doi.org/10.1007/s00167-012-2160-x
19. Nunns M, House C, Rice H, Mostazir M, Davey T, Stiles V, et al. Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines. Br J Sports Med 2016;50(19):1206-10. https://doi.org/10.1136/bjsports-2015-095394
20. Hetsroni I, Finestone A, Milgrom C, Ben-Sira D, Nyska M, Mann G, et al. The role of foot pronation in the development of femoral and tibial stress fractures: A prospective biomechanical study. Clin J Sport Med 2008;18(1):18-23. https://doi.org/10.1097/JSM.0b013e31815ed6bf
21. Hadid A, Epstein Y, Shabshin N, Gefen A. Biomechanical model for stress fracture-related factors in athletes and soldiers. Med Sci Sports Exerc 2018;50(9):1827-36. https://doi.org/10.1249/MSS.0000000000001628
22. Aoki Y, Yasuda K, Tohyama H, Ito H, Minami A. Magnetic resonance imaging in stress fractures and shin splints. Clin Orthop Relat Res 2004;(421):260-7. https://doi.org/10.1097/01.blo.0000126333.13806.87
23. Matheson GO, Clement DB, Mckenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG. Stress fractures in athletes. Am J Sports Med 1987;15(1):46-58. https://doi.org/10.1177/036354658701500107
2. Devas MB. Stress fractures in athletes. Proc R Soc Med 1969;62(9):933-7. PMID: 5823819
3. Milgrom C, Zloczower E, Fleischmann C, Spitzer E, Landau R, Bader T, et al. Medial tibial stress fracture diagnosis and treatment guidelines. J Sci Med Sport 2021;24(6):526-30. https://doi.org/10.1016/j.jsams.2020.11.015
4. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician 2011;83(1):39-46. PMID: 21888126
5. Milgrom C, Giladi M, Stein M, Kashtan H, Margulies JY, Chisin R, et al. Stress fractures in military recruits. A prospective study showing an unusually high incidence. J Bone Joint Surg Br 1985;67(5):732-5. https://doi.org/10.1302/0301-620X.67B5.4055871
6. Brukner P, Bennell K. Stress fractures in female athletes. Sports Med 1997;24(6):419-29. https://doi.org/10.2165/00007256-199724060-00006
7. Gam A, Goldstein L, Karmon Y, Mintser I, Grotto I, Guri A, et al. Comparison of stress fractures of male and female recruits during basic training in the Israeli Anti-Aircraft Forces. Mil Med 2005;170(8):710-2. https://doi.org/10.7205/milmed.170.8.710
8. Franklyn M, Oakes B, Field B, Wells P, Morgan D. Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes. Am J Sports Med 2008;36(6):1179-89. https://doi.org/10.1177/0363546508314408
9. Popp KL, Hughes JM, Smock AJ, Novotny SA, Stovitz SD, Koehler SM, et al. Bone geometry, strength, and muscle size in runners with a history of stress fracture. Med Sci Sports Exerc 2009;41(12):2145-50. https://doi.org/10.1249/MSS.0b013e3181a9e772
10. Protzman RR, Griffis CG. Stress fractures in men and women undergoing military training. J Bone Joint Surg 1977;59(6):825-825. PMID: 908707
11. Brudvig TJ, Gudger TD, Obermeyer L. Stress fractures in 295 trainees: A one-year study of incidence as related to age, sex, and race. Mil Med 1983;148(8):666-7. https://doi.org/10.1093/milmed/148.8.666
12. Abbott A, Bird ML, Wild E, Brown SM, Stewart G, Mulcahey MK. Part I: epidemiology and risk factors for stress fractures in female athletes. Phys Sportsmed 2020;48(1):17-24. https://doi.org/10.1080/00913847.2019.1632158
13. Moran DS, Heled Y, Arbel Y, Israeli E, Finestone AS, Evans RK, et al. Dietary intake and stress fractures among elite male combat recruits. J Int Soc Sports Nutr 2012;9(1):6. https://doi.org/10.1186/1550-2783-9-6.2012
14. Griffin KL, Knight KB, Bass MA, Valliant MW. Predisposing risk factors for stress fractures in collegiate cross-country runners. J Strength Cond Res 2021;35(1):227-32. https://doi.org/10.1519/JSC.0000000000002408
15. Yong JR, Silder A, Montgomery KL, Fredericson M, Delp SL. Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures. J Biomech 2018;76:1-7. https://doi-org/10.1016/j.jbiomech.2018.05.017
16. Swissa A, Milgrom C, Giladi M, Kashtan H, Stein M, Margulies J, et al. The effect of pretraining sports activity on the incidence of stress fractures among military recruits. A prospective study. Clin Orthop Relat Res 1989:(245):256-60. PMID: 2787719
17. Armstrong DW, Rue JPH, Wilckens JH, Frassica FJ. Stress fracture injury in young military men and women. Bone 2004;35(3):806-16. https://doi.org/10.1016/j.bone.2004.05.014
18. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc 2013;21(3):556-63. https://doi.org/10.1007/s00167-012-2160-x
19. Nunns M, House C, Rice H, Mostazir M, Davey T, Stiles V, et al. Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines. Br J Sports Med 2016;50(19):1206-10. https://doi.org/10.1136/bjsports-2015-095394
20. Hetsroni I, Finestone A, Milgrom C, Ben-Sira D, Nyska M, Mann G, et al. The role of foot pronation in the development of femoral and tibial stress fractures: A prospective biomechanical study. Clin J Sport Med 2008;18(1):18-23. https://doi.org/10.1097/JSM.0b013e31815ed6bf
21. Hadid A, Epstein Y, Shabshin N, Gefen A. Biomechanical model for stress fracture-related factors in athletes and soldiers. Med Sci Sports Exerc 2018;50(9):1827-36. https://doi.org/10.1249/MSS.0000000000001628
22. Aoki Y, Yasuda K, Tohyama H, Ito H, Minami A. Magnetic resonance imaging in stress fractures and shin splints. Clin Orthop Relat Res 2004;(421):260-7. https://doi.org/10.1097/01.blo.0000126333.13806.87
23. Matheson GO, Clement DB, Mckenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG. Stress fractures in athletes. Am J Sports Med 1987;15(1):46-58. https://doi.org/10.1177/036354658701500107