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Are Stress and Growth Plate Fractures stressing you out?!    


    The truth is, there are more stress fractures in youth sport now than there were even five years ago.

    Why? Whether this is because there are higher expectations with more difficult skills being done at
    a younger age, increased hours of sport each week, risky diet habits, better diagnosing by doctors,
    better cost effective ways to diagnose (MRI) or something else entirely- we are seeing more and
    more stress fractures in young athletes.

    Where? In baseball, sports care physicians see shoulder (humeral growth plate) stress fractures,
    in gymnasts there are stress fractures in the wrist (radial growth plate), back (spondyloysis), and
    heel, in runners there are stress fractures in the shin, and in dancers there are stress fractures in
    the foot.

    Stress fractures can occur in the middle of bone such as the arm or toe. They can also occur at the
    end of a bone- and in young athletes this can be at a growth plate (epiphysis). There is different
    treatment for each.

                    Diagnosis can be made with a regular xray but often stress fractures are missed with
                             this technique. Persistent pain should be addressed with either a bone scan or MRI.
                            Both are extremely good tests, and each have benefits for the physician to make
                             treatment decisions.


                    Treatment usually involves relative rest (as in a stress fracture in the tibia- lower leg),
                             protection- sometimes with bracing (as in the back with a spondylolysis) or casting (if
    the
                             growth plate in the wrist is involved), or a cam-walker boot (if the heel, foot, or ankle is
                             involved) followed by physical therapy in many cases, and careful reintroduction into
                             sport.

                            Growth plate fractures have special names- Salter Harris type fractures 1 to 5 is an
                            example of labeling the severity of the fracture. Type I fractures can be difficult to see
                            on xray and thankfully heal well in most cases. Types 2-4 require careful treatment and
                            at times even surgery; while Type 5 is the most severe (a crushing injury to the growth
                            plate and requires the most care). Your doctor will help decide if a walking shoe, cam-
                            walker, splint, cast, or surgery is required to protect an injured growth plate. A physical
                            exam, xrays, and sometimes special tests will assist the doctor in making a good
                            decision.

                             If an athlete has more than one stress fracture in their career- I recommend a bone
                             density test (DEXA scan) to get a baseline for bone strength- as repeated stress
                             fractures can be a warning that osteoporosis is down the road.

    What next? A diet history should be taken as eating disorders are sometimes seen in
                       athletes with recurrent stress fractures.

    A Calcium supplement should be considered.

    Kidney, bone, and metabolic syndromes should be ruled out in recurrent fractures as
    medical causes of weak bone.

    Finally, over training and the Female Athlete Triad (eating poorly, menstrual irregularity, and weak
    bones) should be discussed with adolescent and adult female athletes.

    And… There is not always a medical reason for a stress fracture… In some cases, stress
    fractures occur because of a bad landing or simply a bad day at practice!

    See your physician if you are experiencing pain or think you may have a stress fracture.
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