December 16, 2019
Stress Fracture Types & Treatments
Stress fractures are common injuries experienced by people of all ages and activity levels. Learn more about the different types of stress fractures and the treatment options available at Arkansas Surgical Hospital.
Low-Risk Stress Fractures
Low-risk stress fractures can usually heal without requiring surgery. They are not likely to develop complications. Common locations of low-risk stress fractures include your fibula, which is next to your shin bone, and your calcaneus, or heel bone.
Conservative treatment involving RICE (rest, ice, compression, and elevation), NSAIDs (non-steroidal anti-inflammatory drugs), and limited weightbearing is the standard first line of treatment. This treatment can last anywhere from around six weeks to a full year and is typically enough to heal your stress fracture when there are no complications. However, low-risk stress fractures can sometimes progress to high-risk stress fractures if conservative measures do not help.
High-Risk Stress Fractures
Stress fractures are categorized as high-risk if there is a high chance of displacement, delayed union, non-union, or completion (a complete break) of the fracture. These stress fractures often occur in areas with low blood supply, which is necessary for bone development. Examples of these areas include certain bones in your feet, such as the metatarsals (the long, tubular bones in the middle of your foot) and the navicular (a concave bone towards the inner side of your foot).
Other high-risk stress fracture locations include “tension-side” bones, which means they bear weight as your body goes through various movements. Stress fractures in these areas are more likely to become displaced or progress to a complete fracture. One of these locations is the outer side of your femur, or thigh bone.
Finally, bones in areas without much muscle or other soft tissue coverage—such as your tibia, or shin bone—are also prone to high-risk stress fractures. If your stress fracture is in one of these areas, your orthopedic surgeon may recommend surgery. While some high-risk stress fractures heal on their own, surgical intervention is often needed to ensure complete healing.
If your stress fracture does not heal with rest, you may need surgery. There are several different surgical techniques for stress fracture treatment, including screws, wires, rods, and plates designed to help your bone progress to full union.
Displaced Stress Fractures
Displacement is the term used to describe bone edges that have moved out of alignment, which makes it harder for your stress fracture to heal.
Displacement has several risks. For example, displaced stress fractures in your femur can lead to avascular necrosis—the death of bone tissue caused by lack of blood supply—in the ball of your joint, which can cause arthritis or even collapse of the bone.
If your stress fracture is displaced, your treatment will need to be more aggressive. Your bone will need to be immobilized, usually using a cast or splint, and you will need to rest it completely (i.e., no weight-bearing or unnecessary activity) for several weeks. If that does not help, internal fixation using screws or rods is the next step to ensure healing of your stress fracture.
Delayed Union and Non-Union of Stress Fractures
There are several factors that can slow down or even prevent the healing of your stress fracture, including diabetes, hormone imbalance, and unhealthy habits.
In order to ensure complete healing of your stress fracture, you will need to follow your orthopedic surgeon’s instructions on what to do—and what not to do—before, during, and after your treatment. Examples include:
- Stop smoking. Nicotine delays healing and tobacco weakens your bones.
- Improve your diet. Insufficient calcium and vitamin D can make it more difficult for your stress fracture to heal.
- Do not return to activity before your orthopedic surgeon approves it. This could delay healing and may even result in a complete fracture.