Method of Diagnosis

The validity of sports injury data depends on the definition of injury in the study population. Although all of the studies in this review used stress fracture

Table 1

Proportion of athletes with stress fractures

Study

Country

Study design

Sport

Number (M/F)

Data collection

Arendt et al

USA

Retrospective

NCAA

3610/2248

Review of

[8] 2003

medical records

Bennell et al

Australia

Prospective

T-F

49/46

Monitoring

[1] 1996

Brubaker and

USA

Retrospective

T-F

109

Review of

James [1 5]

medical records

1974

Clement et al

Canada

Retrospective

All

987/663

Review of

[11] 1981

medical records

Dixon and

Australia

Retrospective

Gymnasts

42/74

Review of

Fricker [26]

medical records

1993

Goldberg and

USA

Retrospective

NCAA

3000

Review of

Pecora [9]

medical records

1994

Observation proportion proportion period (y) Diagnosis (T/M/F) (T/M/F)

29.7

Harne et al

USA

Retrospective

NCAA

5900

Review of

14

NR

1,4/NR/NR

NR

[10] 2004

medical records

Hickey et al

Australia

Retrospective

Basketball

0/49

Review of

5

NR

NR/NR/40.8

NR

[32] 1997

medical records

Iwamoto and

Japan

Retrospective

All

6415/3861

Review of

10

MRI/BS/XR

1.9/2.0/1.9

NR

Takeda [12]

medical records

2003

Johnson et al

USA

Prospective

NCAA

593/321

Monitoring

2

XR/BS

2.6/NR/NR

3.7/2.0/6.9

[2] 1994

Lloyd et al

USA

Retrospective

NCAA

0/199

Review of

1

XR

NR/NR/6.5

NR

[7] 1986

medical records

Matheson et al

Canada

Retrospective

All

867/540

Review of

5

NR

7.8/5.5/

NR

[13] 1989

medical records

1 1.5

Nattiv et al

USA

Prospective

T-F

275

Monitoring

3

XR/MRI

8.7/NR/NR

NR

[3] 2000

Witman et al

USA

Retrospective

All

680/309

Review of

4.5

NR

0.5/NR/NR

NR

[14] 1981

medical records

Abbreviations: BS, bone scan; F, female; M, male; NCAA, National Collegiate Athletic Association; NR, not recorded; T, total; T-F, track and field; XR, radiography.

Abbreviations: BS, bone scan; F, female; M, male; NCAA, National Collegiate Athletic Association; NR, not recorded; T, total; T-F, track and field; XR, radiography.

as the outcome, the methods of diagnosis varied. When comparing injury data among studies, the diagnostic tool must be considered because it may greatly affect the number of stress fractures reported. For example, Lloyd and colleagues [7] defined cases using only plain radiographs, although there may be a 2- to 4-week delay in stress fracture diagnosis using this method. Thus, stress fracture incidence may be under-reported in studies using only plain radiographs to diagnose stress fracture. Also, tarsal stress fractures are notoriously difficult to diagnose by radiography, potentially resulting in a delayed or missed diagnosis.

Conversely, both MRI and bone scans are sensitive and will detect stress fractures at an early stage. MRI scanning, particularly, is quite sensitive and detects bone "stress injury," a precursor to an actual stress fracture. Studies using MRI scans will likely detect a higher incidence of stress fractures and stress reactions compared with other diagnostic tests. Unfortunately, many of the studies did not identify the method of diagnosis. These studies must be interpreted with caution because the validity of the results cannot be determined.

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