Stress fractures

A stress fracture should be suspected clinically when the patient gives a typical history of pain during exercise. Clinical examination is usually not reliable, and the diagnosis should be confirmed with imaging studies (x-ray, magnetic resonance imaging, bone scan). An early identification is especially important in those stress fractures where a dislocation would necessitate surgical management and thus prolong recovery period. Risk of dislocation is associated, in particular, with femoral neck and shaft fractures. A femoral stress fracture should be suspected in military conscripts and those involved in strenuous exercise who complain of groin, hip, thigh or knee pain, however mild. In order to avoid complications, the patient must be told not to engage in any activities associated with repetitive loading until a stress fracture has been excluded.