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Return to sports after stress fractures of the tibial diaphysis: a systematic review.
Robertson, GA, Wood, AM
British medical bulletin. 2015;(1):95-111
Abstract
INTRODUCTION This review aims to provide information on the time taken to resume sport following tibial diaphyseal stress fractures (TDSFs). SOURCES OF DATA A systematic search of Medline, EMBASE, CINHAL, Cochrane, Web of Science, PEDro, Sports Discus, Scopus and Google Scholar was performed using the keywords 'tibial', 'tibia', 'stress', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT Twenty-seven studies were included: 16 reported specifically on anterior TDSFs and 5 on posterior TDSFs. The general principles were to primarily attempt non-operative management for all TDSFs and to consider operative intervention for anterior TDSFs that remained symptomatic after 3-6 months. Anterior TDSFs showed a prolonged return to sport. AREAS OF CONTROVERSY The best time to return to sport and the optimal management modalities for TDSFs remain undefined. GROWING POINTS Management of TDSFs should include a full assessment of training methods, equipment and diet to modify pre-disposing factors. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for TDSFs.
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2.
Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis.
Wright, AA, Taylor, JB, Ford, KR, Siska, L, Smoliga, JM
British journal of sports medicine. 2015;(23):1517-23
Abstract
BACKGROUND Stress fractures are common overuse injuries with up to 95% occurring in the lower extremities. Among runners, stress fractures account for 15-20% of all musculoskeletal injuries. PURPOSE We systematically reviewed and critiqued the evidence regarding risk factors associated with increased risk of lower extremity stress fractures in runners. STUDY DESIGN Systematic review. METHODS A systematic, computerised literature search of Medline, Embase, PubMed, SPORTDiscus, and CINAHL databases (from database inception through 9 January 2014) using keywords related to risk factors and stress fractures. This systematic review with meta-analysis utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the search and reporting phases of the study. Inverse variance meta-analyses, using a random effects model were used to summarise ORs. RESULTS 8 articles met the inclusion criteria; 7 were considered low risk. 4 articles qualified for meta-analysis. Results of the meta-analysis identified previous history of stress fracture and female sex as the primary risk factors for future stress fracture with a pooled OR of 4.99 (95% CI 2.91 to 8.56; p<0.001; I(2)=0%) and 2.31 (95% CI 1.24 to 4.29; p<0.01; I(2)=0%), respectively. CONCLUSIONS Currently, only previous history of stress fracture and female sex are risk factors for lower extremity stress fractures strongly supported by the data.
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3.
Simultaneous bilateral stress fractures in a homemaker: a case report and literature review.
Yousaf, S, Sugand, K, Raza, M, Ramesh, P
Journal of the American Podiatric Medical Association. 2014;(5):518-21
Abstract
Stress fractures commonly occur in athletes and military cadets due to repetitive stress on the bony cortex. Stress fractures of the tibia are commonly localized proximally and occur during aerobic weightbearing exercises. This is an unusual case of bilateral simultaneous distal tibial stress fracture in a young homemaker.
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4.
Relationship between 25-hydoxyvitamin D, muscle strength, and incidence of injury in healthy adults: a systematic review.
Redzic, M, Lewis, RM, Thomas, DT
Nutrition research (New York, N.Y.). 2013;(4):251-8
Abstract
The purpose of this systematic review is to answer the following clinical questions in healthy adults: is vitamin D status related to (1) muscle strength? (2) or incidence of injury? A literature search was performed using Pubmed, SPORTDiscus, and Web of Science to capture relevant articles that have examined these outcomes. Inclusion criteria required studies to address at least one of the 2 questions stated above, enroll healthy human subjects with a mean age of 18 to 65 years of age, and include serum 25-hydoxyvitamin D measures. Study characteristics such as vitamin D status, study design, and study population were documented. Measured assessors and outcomes from all studies were extracted to answer at least one of the two questions. When applicable, data were used to compute effect sizes at a 95% confidence interval for comparisons across studies to answer the 2 questions. The results of these studies indicate a weak to moderate effect of higher 25-hydoxyvitamin D levels on greater muscle strength and reduced incidence of injury. Randomized controlled clinical trials examining these questions are scarce when compared with the popularity of vitamin D testing; therefore, future trials are necessary to advance our understanding and to clarify the effect vitamin D has on extraskeletal outcomes in healthy adults.
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5.
Prevention of running injuries.
Fields, KB, Sykes, JC, Walker, KM, Jackson, JC
Current sports medicine reports. 2010;(3):176-82
Abstract
Evidence for preventive strategies to lessen running injuries is needed as these occur in 40%-50% of runners on an annual basis. Many factors influence running injuries, but strong evidence for prevention only exists for training modification primarily by reducing weekly mileage. Two anatomical factors - cavus feet and leg length inequality - demonstrate a link to injury. Weak evidence suggests that orthotics may lessen risk of stress fracture, but no clear evidence proves they will reduce the risk of those athletes with leg length inequality or cavus feet. This article reviews other potential injury variables, including strength, biomechanics, stretching, warm-up, nutrition, psychological factors, and shoes. Additional research is needed to determine whether interventions to address any of these will help prevent running injury.
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6.
Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial.
Beck, BR, Matheson, GO, Bergman, G, Norling, T, Fredericson, M, Hoffman, AR, Marcus, R
The American journal of sports medicine. 2008;(3):545-53
Abstract
BACKGROUND Tibial stress fractures increasingly affect athletes and military recruits, with few known effective management options. Electrical stimulation enhances regular fracture healing, but the effect on stress fractures has not been definitively tested. HYPOTHESIS Capacitively coupled electric field stimulation will accelerate tibial stress fracture healing. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Twenty men and 24 women with acute posteromedial tibial stress fractures were referred from local clinicians. Subjects were randomly assigned active or placebo capacitively coupled electric field stimulation to be applied for 15 hours per day until healed, given supplemental calcium, and instructed to rest from provocative training. Healing was confirmed when hopping to 10 cm for 30 seconds could be achieved without pain. RESULTS No difference in time to healing was detected between treatment and placebo groups. Women in the treatment group healed more slowly than did the men (P = .05). Superior treatment compliance was associated with reduced time to healing (P = .003). Rest noncompliance was associated with increased time to healing (P = .05). CONCLUSION Whole-group analysis did not detect an effect of capacitively coupled electric field stimulation on tibial stress fracture healing; however, greater device use and less weightbearing loading enhanced the effectiveness of the active device. More severe stress fractures healed more quickly with capacitively coupled electric field stimulation. CLINICAL RELEVANCE Although the use of capacitively coupled electric field stimulation for tibial stress fracture healing may not be efficacious for all, it may be indicated for the more severely injured or elite athlete/recruit whose incentive to return to activity may motivate superior compliance.
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7.
Efficacy of different dosing schedules of etidronate for stress shielding after cementless total hip arthroplasty.
Yamaguchi, K, Masuhara, K, Yamasaki, S, Fuji, T
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2005;(1):32-6
Abstract
Forty-four women who had undergone cementless total hip arthroplasty (THA) were selected for determination of the optimum dosage of etidronate in the treatment of stress shielding after surgery. Patients were 55-86 years of age. The patients were randomized into three groups. The control group (n = 17) was not treated with osteoactive drugs. The low-dose group (n = 12) and the high-dose group (n = 15) received 200 mg or 400 mg etidronate daily for 2 weeks, followed by 12 weeks of calcium supplementation of 500 mg/day. These patients received four cycles of therapy over 1 year postoperatively. Periprosthetic bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at 3 weeks, 6 months, and 12 months. At 12 months, bone loss in the low-dose and high-dose groups was significantly lower compared with the control group in Gruen zones 1 and 7. There were additional significant differences with regard to bone loss between the control group and the high-dose group in zones 2, 4, and 6. Our data suggest that high dosages are more effective in reducing postoperative bone loss after cementless THA.
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8.
[Bioactive calcium phosphate paste injection for repair of vertebral fracture due to osteoporosis].
Takemasa, R, Yamamoto, H
Nihon rinsho. Japanese journal of clinical medicine. 2002;:696-703