Lower-extremity stress fractures account for an estimated 16% of all injuries among runners. The April 2016 “Case Connections” article sprints forward from an April 13, 2016, Case Connector report about a stubborn running-related stress fracture of the inferior pubic ramus that did not respond to the usually successful conservative approach.
It’s often challenging for orthopaedists to make a diagnosis in a patient group in whom multiple musculoskeletal injuries or ailments may exist. Patients with suspected stress fractures may have radiographs with subtle, easily overlooked findings. A bone scan and/or other advanced imaging are often required to make a definitive fracture diagnosis.
Continued running due to a missed diagnosis or a patient’s ardent noncompliance can culminate in complications that may eventually require surgical intervention. The best outcomes are perhaps achieved in a setting that fosters strong collaboration between the surgeon, patient, physiatrist, and/or physical therapist with expertise in the mechanisms and physiology of running.
In a postscript to this Case Connections article, JBJS Case Connector co-editor Tom Bauer, MD describes his fateful experience with a calcaneal stress fracture while running the 2013 Boston Marathon.