Complete tibia and other bone Fractures may result without collision in sport from overtraining, overuse stress fractures if an activity continues without rest and proper treatment.
“Risk Factors for Stress Fracture
Consuming more than 10 alcoholic drinks per week
Excessive physical activity with limited rest periods
Female athlete triad (eating disorders, amenorrhea, osteoporosis)
Low levels of 25-hydroxyvitamin D
Recreational running (more than 25 miles per week)
Sudden increase in physical activity
Track (running sports)”
“Certain stress fractures may lead to complications, including progression to complete fractures, development of avascular necrosis, or delays in healing or nonunion. Examples of these high-risk stress fractures include the superolateral femoral neck, patella, anterior tibia, medial malleolus, talus, tarsal navicular, and the fifth metatarsal.22 High-risk stress fractures may warrant consultation with an orthopedist or sports medicine subspecialist.
In special circumstances, such as in competitive athletes during their sport’s season, patients may choose to modify their activity to a decreased level of intensity (tolerable without exacerbation), and delay complete rest until the season is finished.22
In these situations, athletes should be aware of the potential for prolonged recovery or the need for additional interventions, including surgery”
[Stress Fractures: Diagnosis, Treatment, and Prevention, Deepak S. Patel, MD, Matt Roth, MD, Neha Kapil, MD, Am Fam Physician. 2011 Jan 1;83(1):39-46.]
“1. Fayad LM, Kamel IR, Kawamoto S, Bluemke DA, Frassica FJ, Fishman EK. Distinguishing stress fractures from pathologic fractures: a multimodality approach. Skeletal Radiol. 2005;34(5):245–259.
2. Niva MH, Mattila VM, Kiuru MJ, Pihlajamäki HK. Bone stress injuries are common in female military trainees: a preliminary study. Clin Orthop Relat Res. 2009;467(11):2962–2969.
3. Brukner P, Bradshaw C, Khan KM, White S, Crossley K. Stress fractures: a review of 180 cases. Clin J Sport Med. 1996;6(2):85–89.
4. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med. 1987;15(1):46–58.
5. Ohta-Fukushima M, Mutoh Y, Takasugi S, Iwata H, Ishii S. Characteristics of stress fractures in young athletes under 20 years. J Sports Med Phys Fitness. 2002;42(2):198–206.
6. Lappe J, Davies K, Recker R, Heaney R. Quantitative ultrasound: use in screening for susceptibility to stress fractures in female army recruits. J Bone Miner Res. 2005;20(4):571–578.
7. Clement DB, Ammann W, Taunton JE, et al. Exercise-induced stress injuries to the femur. Int J Sports Med. 1993;14(6):347–352.
8. Ruohola JP, Laaksi I, Ylikomi T, et al. Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men. J Bone Miner Res. 2006;21(9):1483–1488.
9. Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–1882.
10. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995;23(4):472–481.
11. Ishibashi Y, Okamura Y, Otsuka H, Nishizawa K, Sasaki T, Toh S. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med. 2002;12(2):79–84.
12. Batt ME, Ugalde V, Anderson MW, Shelton DK. A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc. 1998;30(11):1564–1571.
13. Lesho EP. Can tuning forks replace bone scans for identification of tibial stress fractures? Mil Med. 1997;162(12):802–803.
14. Zukotynski K, Curtis C, Grant FD, Micheli L, Treves ST. The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain. J Orthop Surg Res. 2010;5:13.
15. Daffner RH, Weissman BN, Bennett DL, et al., Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria stress/insufficiency fracture, including sacrum, excluding other vertebrae. Reston, Va.: American College of Radiology; 2008. http://www.guideline.gov/content.aspx?id=13668. Accessed March 10, 2010.
16. Gaeta M, Minutoli F, Scribano E, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology. 2005;235(2):553–561.
17. Banal F, Gandjbakhch F, Foltz V, et al. Sensitivity and specificity of ultrasonography in early diagnosis of metatarsal bone stress fractures: a pilot study of 37 patients. J Rheumatol. 2009;36(8):1715–1719.
18. Groves AM, Cheow HK, Balan KK, Housden BA, Bear-croft PW, Dixon AK. 16-Detector multislice CT in the detection of stress fractures: a comparison with skeletal scintigraphy. Clin Radiol. 2005;60(10):1100–1105.
19. Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. AJR Am J Roentgenol. 2004;183(3):635–638.
20. Rome K, Handoll HH, Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005;(2):CD000450.
21. Lappe J, Cullen D, Haynatzki G, Recker R, Ahlf R, Thompson K. Calcium and vitamin D supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res. 2008;23(5):741–749.
22. Kaeding CC, Yu JR, Wright R, Amendola A, Spindler KP. Management and return to play of stress fractures. Clin J Sport Med. 2005;15(6):442–447.
23. Wheeler P, Batt ME. Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med. 2005;39(2):65–69.
24. Rue JP, Armstrong DW III, Frassica FJ, Deafenbaugh M, Wilckens JH. The effect of pulsed ultrasound in the treatment of tibial stress fractures. Orthopedics. 2004;27(11):1192–1195.
25. Beck BR, Matheson GO, Bergman G, et al. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am J Sports Med. 2008;36(3):545–553.
26. Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2008;90(11):2322–2330.
27. Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: a systematic review of health outcomes. Evidence report no. 183. Rockville, Md.: Agency for Healthcare Research and Quality; August 2009. AHRQ publication no. 09-E015.
28. Milgrom C, Finestone A, Novack V, et al. The effect of prophylactic treatment with risedronate on stress fracture incidence among infantry recruits. Bone. 2004;35(2):418–424.
29. Friedl KE, Evans RK, Moran DS. Stress fracture and military medical readiness: bridging basic and applied research. Med Sci Sports Exerc. 2008;40(11 suppl):S609–S622.”