Stress Fractures

Abstract

Prijelomi zamora čest su problem, a ovisno o medicinskoj ustanovi ti prijelomi čine između 1,1 i 3,7% svih ozljeda u sportaša. Brojni su čimbenici koji pogoduju nastanku prijeloma zamora. U žena se vrlo često ističe kao uzrok nastanka prijeloma zamora i hormonalni disbalans (trijas sportašica). Za postavljanje dijagnoze najvažnije je pomisliti na mogućnost postojanja prijeloma zamora. Stoga i jest klinički pregled osnovni postupak na koji se potom nadovezuju druge dijagnostičke metode: radiološka, scintigrafska, a u posljednje doba i magnetska rezonancija. Za najveći broj prijeloma zamora dovoljno liječenje jest prekid sportske aktivnosti u trajanju od 4 do 6 tjedana. Postoje i prijelomi zamora visokoga rizika u koje ubrajamo prijelome vrata i trupa bedrene kosti, prijelom prednjeg dijela srednje trećine tibije, prijelom navikularne kosti, prijelom baze pete metatarzalne kosti (Jonesov prijelom) te prijelom zamora sezamske kosti nožnoga palca. Ti prijelomi zahtijevaju posebno dugotrajnije liječenje, a katkad i kirurško.Stress fractures are common overuse injuries, ranging between 1.1% and 3.7% of all athletic injuries. Causes are many and usually involve repetitive submaximal stress. There is a wide research evidence showing that training errors cause stress fractures in as many as 22% to 75% of cases. Intrinsic factors such as hormonal imbalance may also contribute to the onset of stress fractures, especially in women. During medical examination, it is essential always to bear in mind the possibility of stress fracture. Clinical diagnosis is therefore the basic procedure, followed by other diagnostic methods in the following order: radiology, scintigraphy, and MRI. Most stress fractures are uncomplicated and can be managed through rest and restriction from precipitating activities for 4-6 weeks. A subset of stress fractures can present a high risk for progression to complete fracture, delayed union, or nonunion. Specific sites for this type of stress fracture are the femoral neck, the anterior cortex of the tibia, the tarsal navicular, the fifth metatarsal (Jones fracture), and the great toe sesamoids. Therefore, high-risk stress fractures require aggressive treatment, and in some cases even surgical intervention is appropriate