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Overview of stress fractures

Kevin deWeber, MD, FAAFP, FACSM
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


As defined below, stress fractures are overuse injuries to bones caused by repetitive stresses, either tensile or compressive. Stress fractures may be the result of a small number of repetitions with a relatively large load (eg, a military recruit marching for several miles with a heavy backpack), a large number of repetitions with a usual load (eg, an athlete training for a long-distance race), or a combination of increased load and increased repetitions.

An overview of the classification, risk factors, diagnosis, management, and prevention of stress fractures is presented here. Specific stress fractures are discussed separately. (See "Stress fractures of the tibia and fibula" and "Stress fractures of the metatarsal shaft" and "Stress fractures of the humeral shaft" and "Proximal fifth metatarsal fractures", section on 'Stress fractures of the proximal diaphysis'.)


Fracture – Fracture refers to the breaking of a bone. Complete fractures divide the affected bone into two or more pieces, while partial (incomplete) fractures do not extend through the cortex. An example of an incomplete fracture is the "greenstick" fracture, in which the convex side of a long bone is disrupted, while the concave surface remains intact. These are most common in children.

Stress fracture – A stress fracture occurs when a bone breaks after being subjected to repeated tensile or compressive stresses, none of which would be large enough individually to cause the bone to fail, in a person who is not known to have an underlying disease that would be expected to cause abnormal bone fragility.

Insufficiency fracture – An insufficiency fracture occurs when the mechanical strength of a bone is reduced to the point that a stress, which would not fracture a healthy bone, breaks the weak one. The condition that causes reduced bone strength typically does so throughout the skeleton (eg, osteoporosis, osteomalacia, or osteogenesis imperfecta) but may be more localized (eg, demineralization in a limb due to disuse).

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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