UW Health Sports Medicine 

Sports Medicine Corner: Bone injuries


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June 9, 2010

Turf toe? What in the world is turf toe? University of Wisconsin graduate assistant athletic trainer Ryan Dean answers questions many fans have about common sports injuries in a new series on UWBadgers.com, The Sports Medicine Corner. In part four of the series, Dean examines the differences between the three degrees of bone injuries.


MADISON, Wis.
-- The human body is composed of various kinds of tissues. Skin, muscle, connective tissue, and all are susceptible to injury. Bones are no different, and similar to other tissues, bones can undergo varying degrees of injury.  

While most people think of a bone injury as simply a fracture, there are two other conditions that can occur, stress reaction and stress fractures. Today we examine the three degrees of boney injury.

Stress Reaction
A stress reaction is the lowest grade of the three levels of bone injury. A stress reaction is essentially the early stages of a stress fracture. This occurs when the stresses affecting the bone occur at a faster rate than the rate at which the bone is able to rebuild itself.

These stresses typically occur from repetitive impacts to the bone like those seen in cross-country runners or a gymnast. A stress reaction will initially present as localized (a specific spot) pain over the bone.

These injuries are hard to diagnose because they do not show up on normal x-rays. Instead, to “see” a stress reaction, the athlete must undergo a bone scan which will show increased bone building in the area of the reaction. If diagnosed, the athlete will typically be advised to stop activity and rest.

Stress Fracture
A stress fracture is the next stage in the progression of bone injury. A stress fracture will occur if a stress reaction continues without being recognized or if the athlete continues activity despite being advised to rest. In these injuries, the bone actually begins to break from the repeated stress.  

As opposed to a stress reaction, some stress fractures can actually be seen with an x-ray. Other methods of imaging to diagnose a stress fracture can include a bone scan, CT scan, or MRI.  Just like a stress reaction, the typical treatment for a stress fracture includes rest.

While any bone is susceptible to a stress fracture, the bones of the lower leg have a higher risk of these injuries. This can be attributed to the weight-bearing properties of these bones. Examples of bones that are common sites for stress fractures are the tibia and fibula (lower leg bones), the navicular (ankle bone), and the metatarsal bones of the foot.

Other Fractures
The first thing that comes to mind when one thinks of a bone injury is a broken bone, or a fracture.

A fracture typically occurs in one of two ways. First, a fracture can occur from a high stress or trauma to the bone from an outside force such as being hit by another object or colliding into another object. The second way a fracture can occur is when a stress reaction is left untreated and eventually develops into a stress fracture.  

Fractures can usually be diagnosed using an x-ray, but sometimes an MRI may be necessary.  Treatment for fractures can vary greatly; in some cases, the bones must be put back into place, or set. This can be done by setting the bones and applying an external cast or by surgically joining the bones using plates, pins, and/or screws. In some cases however, the bone may not need a cast or surgery and rest is the main form of treatment.

While a broken bone can be a traumatic injury, bone injuries typically heal faster than soft tissue injuries like muscle, tendon and ligament damage. This is because bones are very well vascularized; they have excellent blood flow.

The more blood that gets to the injury site, the faster the injury will heal.

--
Ryan Dean
UW Sports Medicine

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