Treatment

Absolute rest is almost never an essential part of the treatment

• relative rest to achieve pain relief combined with a means of maintaining some fitness is essential and is a principle much more readily accepted by athletes
  • a stress fracture may require months of avoidance of a particular activity in order to heal. During this period an athlete may become very frustrated and other methods of maintaining fitness, eg swimming, cycling on an exercise bike (if this activity does not cause pain), can be undertaken
  • immobilisation of a fracture site while weight-bearing in a functional Aircast® brace is often effective, with the advantage that the splint can be removed when not weight-bearing
    • plaster casts are now seldom necessary except for occasional patients who may be tempted to bear weight without the Aircast® splint in place
    • surgical fixation is also usually unnecessary but is the management of choice in some circumstances

Remind the patient that pain is the way their body tells them that something is wrong, and so an activity that causes pain at the site of the fracture should be avoided.

Some management principles for specific stress fractures (1):

• femoral neck stress fracture:
  • sports associated: distance running
  • treatment:
    • distraction side (superior) requires urgent surgical review
    • compression (inferior) side can be managed with non-weight bearing (NWB) and relative rest
• tibia stress fracture:
  • sports associated: distance running
  • treatment:
    • anterior tibial (distraction) and medial (compression) can be managed with Aircast® brace followed by gradual reintroduction of weight bearing (WB)
      • distraction fractures usually require prolonged treatment (6–12 months)
• navicular bone stress fracture:
  • sports associated: athletics, football, rugby
  • treatment:
    • NWB plaster cast immobilisation for 6–8 weeks
  • some advocate surgical fixation but we have successfully managed conservatively
• 2nd metatarsal stress fracture
  • activities associated: ballet dancing
  • treatment:
    • NWB immobilisation (Aircast®) for 2 weeks with partial WB for further 2 weeks
• 5th metatarsal stress fracture
  • activities associated: ballet, endurance WB, tennis
  • treatment:
    • NWB plaster cast immobilisation for 6–8 weeks or surgical fixation
• sesamoid bone stress fracture:
  • activities associated: ballet, dancing, running
  • treatment:
    • NWB immobilisation (Aircast®) for up to 6 weeks

Reference:

• (1) ARC. Sports-Related Musculoskeletal Disorders. Reports on the Rheumatic Diseases 2008;14.