Phys Sportsmed. 2022 Nov 3. doi: 10.1080/00913847.2022.2143247. Online ahead of print.
OBJECTIVES: To present one of the first descriptive case series of pediatric and adolescent lower extremity stress injuries, their management and outcomes in athletes and non-athletes.
METHODS: : IRB-approved retrospective study included patients under 18 years at a tertiary children’s hospital who were diagnosed with a lower extremity stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, & outcomes were collected. Descriptive statistical analysis was conducted.
RESULTS: 97 patients with stress injuries on clinical exam and on radiographs or MRI were included. Average age when diagnosed was 11.7 years (range 1.1-18 years) and the most common injuries were to the tibia (n=33, 28.4%) and the least common involved were the cuneiforms (n=4, 3.4%). Patients under the age of 14 were more likely to experience cuboid and calcaneal stress injuries (mean age 5.5 and 8.3 years respectively). 19 patients (19.6%) had high-risk stress fractures, with the average age of 14.9 years versus 11.6 for those with low risk (p-value=0.01) and return to activity time being 15 weeks compared to 10.5 (p-value=0.027). The most common forms of treatment were controlled ankle motion (CAM) walker boots (58.6%) and physical therapy (PT) (38.1%). Mean Lower Extremity Function Score of the patient population was 73.8, indicating no clinically important difference from full functionality.
CONCLUSION: Lower extremity stress injuries in this cohort were most seen in the tibia, although patients younger than 14 had a high number of cuboid and calcaneal stress injuries. Those with high-risk stress fractures were older and took longer to recover when compared to low-risk injuries. Treatment is commonly conservative, with CAM boots and PT being the most frequently utilized interventions and serving as a successful approach to treatment, with patients returning to activity at an average of 11.4 weeks, which is comparable to similar studies.