What Is a Shin Stress Fracture?
Stress fracture is a kind of skeletal stress fracture injury caused by excessive use. When the muscle is fatigued after being used excessively, it cannot absorb the vibration generated by repeated collisions in time and conduct stress to the bone, which can cause small bone fractures or fractures.
Stress fracture
- Stress fracture is a kind of skeletal stress fracture injury caused by excessive use. When the muscle is fatigued after being used excessively, it cannot absorb the vibration generated by repeated collisions in time and conduct stress to the bone, which can cause small bone fractures or fractures.
Stress fracture introduction
- Stress fractures, also known as fatigue fractures or cumulative strains, are a type of bone damage caused by excessive use. When muscles are fatigued after excessive use, they cannot absorb shocks generated by repeated collisions in time and conduct stress to the bones. Repeated, minor direct or indirect injuries can cause small bone fractures or fractures in specific areas. Stress fractures mostly occur in the body's load-bearing parts, such as the tibia and fibula of the lower leg and the foot (calcaneus, scaphoid, sacrum). Vulnerable groups are athletes with heavy foot loads, such as basketball, football, and tennis players, as well as track and field, gymnasts, and ballet dancers.
- Yao Ming has recently been threatened by a foot injury again, and this time a bone laceration is likely to threaten his career, and this time Yao Ming's bone fracture still belongs to the category of stress fractures.
Causes of stress fractures
- Fractures generally occur in more intense confrontational exercises. Running fractures are different from ordinary fractures. They are usually fatigue fractures caused by the cumulative effect of the ground over time. This type of fracture is also called stress fracture. The tibia is the most prone to fracture during running. The other sites prone to stress fractures are in order of the frequency of occurrence: toes, fibula, femur, ankle and pubic bone. Before a stress fracture occurs, runners usually feel localized pain. This pain is not serious when resting and walking, but it is exacerbated as soon as you start running. This is usually the most important indicator for diagnosing stress fractures.
- Stress fracture is a fracture caused by the breakdown of the mechanical strength of the bone. The factors that cause the breakdown are:
- 1. Continuous, long-term or repeated stress acts on the stressed bone;
- Stress fracture
- 2. The strength of the bone itself. Stress fractures commonly found in the foot are the second metatarsal, calcaneus, talus, fibula, and scaphoid. The calcaneus is more common in children, and the talus and fibula can be produced in adults and children. The second metatarsal bone is more common among athletes, recruits, especially female recruits (approximately 25%). The history of trauma from fatigue fractures can be ambiguous. Pain occurs after exercise and relieves after rest. Pain occurs after the diseased bone is stressed. Examination revealed local swelling and tenderness. Early X-ray films showed that the fracture line was unclear, and later, clear fracture lines were seen, and epiphysis was formed.
Pathogenesis of stress fractures
- Treatment is based on local rest, no weight-bearing activities or plaster fixation. March fractures are most common in foot fractures. Occurs in the second metatarsal bone, followed by the third metatarsal bone. In recent years, biomechanical studies have found that the weight of each foot walking from the first metatarsal gradually decreases from the first metatarsal to the fifth metatarsal (I26%, II20.2%, III11.8%, IV7.6%, V5.5%). The weight of the second metatarsal bone is larger than the other three metatarsal weight-bearing areas, second only to the first metatarsal bone, but the area of the second metatarsal weight-bearing area is half that of the first metatarsal bone. The pressure (pressure / area) in the second metatarsal region is thus greater than that in the first metatarsal. The cortical bone of the first metatarsal shaft is thick and has strong internal muscle attachment. The narrowest cross-section of the metatarsal shaft is twice that of the second metatarsal shaft. One cheekbones. This is enough to explain the most common cause of fatigue fractures in the second metaphysis. The cause of scaphoid fatigue fracture is also related to the stress concentration. Recent biomechanical studies have proven that a tripod-like structure with a full load is wrong. According to the biomechanical measurement, the weight of the weight when standing is 83% of the weight of the medial longitudinal arch, which is the main part of the weight. The scaphoid is the apex of the medial longitudinal arch and suffers the most stress, so it is more prone to fatigue fractures than other sacrums.
Medical diagnosis of stress fractures
- Some inspection methods to determine whether there is a stress fracture:
- 1. A part of the body (usually in the lower extremity) has not experienced sudden external pain and has sudden pain, and this kind of pain makes people unable to continue running or it is difficult to continue running.
- 2, local pain when standing on one foot, or pain when jumping on one foot.
- 3, with the fingers tenderness appears painful feeling.
- 4. Pain points will be eliminated naturally within a period of time after stopping running completely.
Frequency of stress fractures
- Surveys in the United States show that the incidence of stress fractures ranges between 5% and 30%, with slight variations depending on the sport and other risk factors. Black races occur less frequently than Caucasians (whites) because the former have higher bone density.
- Women and more active people are at higher risk. Incidence is likely to increase with age, as bone density decreases with age. But children are also at higher risk because their bones have not yet reached full density and strength. The triad of female athletes (irregular diet, osteoporosis, irregular menstruation) may also put women at risk of injury, because irregular diet and osteoporosis can seriously weaken bone tolerance.
Grading of stress fractures
- Grade 0 (normal reconstruction): new periosteal bone formation, no abnormal changes in X-ray films, no clinical symptoms, but small linear absorption increase in bone scan;
- Grade 1 (mild stress response): Reconstruction of cortical bone, patients may have local pain after exercise, no tenderness, negative X-rays, but positive bone scan;
- Grade 2 (moderate stress response): Cortical bone resorption is slightly stronger than periosteal response, and pain and tenderness may occur. The X-ray film has a complete bone shape, with blurred signs, and a positive bone scan;
- Grade 3 (severe stress response): Periosteal reaction and cortical bone resorption range are enlarged, pain persists, and it also appears at rest. X-ray film shows thickening of cortical bone and positive bone scan;
- Grade 4 (stress fracture): Bone biopsy shows osteonecrosis, trabecular bone microfracture and granulation tissue formation. Due to pain, weight bearing is almost impossible. X-ray film shows fracture and early callus formation, and bone scan is positive. Grade 0 for stress fractures based on MRI (nuclear magnetic resonance) manifestations: T1, T2, and STIR images are normal;
- Grade 1: T2 and STIR images show moderate periosteal edema;
- Grade 2: T2 and STIR images show obvious periosteum and bone marrow edema;
- Grade 3: T1 image shows bone marrow edema, T2 and STIR images show severe edema of the periosteum and bone marrow;
- Grade 4: T1 image shows bone marrow edema with low density signal shadow (fracture line), T2 and STIR image have severe bone marrow edema.
Medical analysis of stress fractures
- From a medical point of view, stress fractures are also known as fatigue fractures. Unlike open fractures, fractures do not occur instantaneously, but cause fractures when the bones reach fatigue points. This kind of fracture can be treated conservatively or surgically, but in terms of treatment plan and process, it is much more complicated. Former NBA legend Bill Walton fell on stress fractures.
- Stress fracture
Stress fracture treatment
- If stress fractures occur in load-bearing bones, continued stress on the injured limb can lead to prolonged or even incurable treatment.
- Rest is the only way to fully treat stress fractures. The time required for recovery varies greatly, and the influencing factors include the location of the injury, the severity, the strength of the self-repair function of different individuals, and the individual's nutritional intake. It usually takes 4-8 weeks of complete rest and is protected with plaster or protective boots. Resting for 12-16 weeks is not uncommon. At the end of this period, you can gradually resume your activities to the extent that it does not cause pain. After the bone feels healed and no longer feels pain in daily activities, the process of bone reconstruction may still last for several months after the wound is healed, during which time the risk of bone fractures remains high. Exercises such as running or other extra stress on the bone can only gradually recover. A basic principle is that the increase in training volume per week cannot exceed 10%.
- Rehabilitation usually includes training in muscle strength, which can help disperse the force exerted on the bones.
- The use of protective gear or hard plastic boots or air cushions to fix limbs is a proven and effective means of reducing the stress on stress fracture sites. An air cushion with an inflatable honeycomb will cause some slight pressure on the bones, which can speed up the blood circulation of the injured part and promote recovery. This method also reduces pain due to external forces on the bones. If the stress fracture of the leg or foot is severe, crutches can also help reduce the pressure on the bones.
- In cases where stress fractures are severe, surgery may also be required for better treatment. The operation may include implantation of nails to fix the fracture site, and the recovery time may take up to six months.
Rehabilitation treatment of stress fracture in the late stage of fracture
Stress fracture requirements
- Early and systematic functional exercise can not only maintain the body's normal physiological function level, accelerate fracture healing, prevent dysfunction adjacent to the terminal injured joint, but more importantly, can prevent injuries caused by muscle adhesion, joint stiffness and muscle atrophy. Permanent dysfunction of the joints, maximizing the restoration of the patient's limb function, preventing disuse atrophy of the limb and joint contracture.
Daily methods for stress fractures
- Extremity stress fractures, especially the rehabilitation of joints and peri-articular fractures, the most important thing is joint mobility and muscle training. Early joint mobility training should be based on passive activities, and the principle of gradual progress should be mastered. If conditions permit, continuous passive activity machines can be used for functional training. Active joint activities can be gradually strengthened 3 days after surgery. Rehabilitation training should gradually increase and maintain the maximum joint mobility, and avoid small-scale fast-paced activities. This will not only help improve joint mobility, but also affect the local fracture.
- Strength training: the human body has different emphasis on the functions of the upper and lower limbs, and the upper limbs focus on fine movements. The recovery of these functions is the focus of functional training. When exercising, pay attention to the maximum flexion and extension of fingers to prevent stiffness and adhesion of hand joints. The main function of the lower extremity is weight bearing, but before the healing of the lower extremity fracture, if the excessive weight bearing will cause the fixation to loosen and break, the rehabilitation of the lower extremity fracture must follow the principle of "early activity and late weight bearing". The quadriceps is an important muscle on the anterior side of the thigh. It is easy to shrink after a long period of inactivity after injury and after surgery, and it is difficult to recover once atrophy, which directly affects the result of functional rehabilitation.
Key points of stress fractures
- Inappropriate muscle strength training and joint activity training can aggravate spasm, and proper rehabilitation training can alleviate this spasm and make the body movements more coordinated.
- According to statistics from the US National Health Center, nearly 20% of patients with stress fractures of the limbs clinically have left disused atrophy of the limbs and joint contractures to varying degrees because of incorrect limb rehabilitation training, which has caused a lot of future life. Great influence. Because once the wrong training method is used, such as repeatedly practicing hard grips with the affected hand, the flexor synergy of the affected upper limb will be strengthened, causing muscle spasms responsible for joint flexion to increase, causing elbow flexion, wrist flexion, pronation, Flexion deformity makes it more difficult to restore hand function.
- In fact, muscle wasting limbs and dyskinesias are not only a problem of muscle weakness, but the uncoordinated muscle contraction is also an important cause of motor dysfunction. Therefore, one cannot mistake the rehabilitation training as strength training. In the rehabilitation treatment of limb muscle strength and limb function recovery after fracture, the traditional ideas and methods are only focused on restoring the muscle strength of the patient, ignoring the rehabilitation treatment of the patient's joint mobility, muscle tension and antagonism. Even if the patient's muscle strength returns to normal, abnormal movement patterns may be left behind, which hinders the improvement of his daily life and activity.
- Experimental and clinical studies have shown that at present domestic and international general recommendations in the daily home nursing rehabilitation after limb fractures, the use of a home-type multifunctional limb movement rehabilitation instrument to restore damaged muscle atrophy limb movement. It is based on nerve facilitation technology, which enables the muscle groups of the limbs to simulate normal movement in a certain order after being subjected to low-frequency pulse electrical stimulation. In addition to directly exercising the muscle strength of the limbs, it coordinates and governs the functional status of the limbs by simulating the passive antagonism of movement. At the same time, it can restore dynamic balance; at the same time, repeated repetitive movements can feed back to the brain to facilitate communication, enable it to maximize functional reconstruction as soon as possible, break spasm patterns, and restore autonomous motion control, especially when it is easy to operate at home. This method can make the limb muscle strength training and joint activity of the fracture patients recover as quickly and completely as possible, and avoid the long-term disuse of atrophy and joint contracture of the injured joint caused by muscle adhesion, joint stiffness and muscle atrophy.
Stress fracture Yao Ming foot injury
- Yao Ming is threatened by a foot injury again, and this time a bone laceration is likely to threaten his career. In fact, in recent years Yao Ming has been struggling with a foot injury. This is also certain. The degree affected his game and play. This time Yao Ming's fractures still belong to the category of stress fractures. Regarding Yao Ming's treatment, the rocket has not come up with a set of accurate and feasible solutions. The healing of stress fractures is generally slower, and the bones and bones move for 100 days. Such fractures need at least 2-3 months to recover. Cycle, and then normal training can be carried out. In fact, surgery and non-surgery do not have much impact on the recovery period. The only difference is that the corresponding training can be performed after surgery. Without surgery, you can only rest completely. It's hard for a player to accept.
- Illustration of Yao Ming's Stress Fracture