Best Practice Case Studies-Case 113 Asset 4 High Grade Stress Fractures

Video Transcription

Video Summary

The session opens the AMSSM National Fellow Online Lecture Series, with housekeeping notes (mute/video off, submit questions via chat, complete the post-lecture evaluation) and promotion of the next talk on February 3. Dr. Kevin Vincent (University of Florida) then presents on diagnosing and managing high-risk stress fractures.<br /><br />He explains stress injury as a continuum from asymptomatic bone edema to a visible fracture line, emphasizing that “stress reaction” on MRI still represents low-grade stress injury. Key causes include insufficient recovery, abnormal loads on normal bone, or normal loads on abnormal bone (e.g., RED-S/female athlete triad, low vitamin D). Muscle flexibility and strength are highlighted as critical for force dissipation; limited ankle dorsiflexion or toe extension can shift forces to bone.<br /><br />Dr. Vincent reviews history and exam clues (insidious onset, night “toothache” throbbing, progression with activity, point tenderness, hop test, fulcrum test for femur). X-rays are often negative; MRI grading predicts healing time. He differentiates low-risk versus critical fractures and details management for high-risk sites including femoral neck (tension vs compression), anterior tibia, medial malleolus, talus, navicular (favoring strict non-weight-bearing casting with high union rates), and proximal fifth metatarsal. He concludes with practical return-to-run planning, expectation management, and addressing biomechanics and training errors—often via specialized physical therapy.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 113

Topic Ankle

Keywords

4th Edition

Ankle

AMSSM National Fellow Online Lecture Series

high-risk stress fractures

stress injury continuum

MRI grading and diagnosis

RED-S and female athlete triad

femoral neck stress fracture

navicular stress fracture non-weight-bearing cast

return-to-run rehabilitation and biomechanics

4th Edition, Case 113