Stress Fracture Management: Current Classification and New Healing Modalities

Stress or fatigue fractures are readily appreciated in sports medicine. Although the general principles of rest, activity modification, and analgesia are accepted by the injured athlete, return to play is a key focus, particularly for competitive athletes. Any intervention will be tried in the hope that it will aid recovery and accelerate return to play. The factors determining prognosis will be discussed on the basis of upon the site of the fracture and the imaging characteristics. This article will also present the general management principles and the factors that guide return to play decisions. There are many new stylistic modalities that are being adopted in an attempt to stimulate bone healing. Current evidence for the biological therapies of hyperbaric oxygen therapy, bisphosphonates, growth factors, bone morphogenic protein, and recombinant parathyroid hormone will be considered, together with the physical modalities of ultrasound and electromagnetic field stimulation.