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Original Contributions |

Fatigue, Insufficiency, and Pathologic Fractures

Richard L. Pentecost, MD; Robert A. Murray, MD; Hanes H. Brindley, MD
[+] Author Affiliations

Read before the Section on Orthopedic Surgery at the 112th Annual Meeting of the American Medical Association, Atlantic City, NJ, June 18, 1963.


Temple, Tex

Dr. Pentecost is a resident in orthopedic surgery, and Drs. Murray and Brindley are from the Department of Orthopedic Surgery of the Scott and White Clinic.


JAMA. 1964;187(13):1001-1004. doi:10.1001/jama.1964.03060260029006
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A partial or complete fracture which results from the inherent inability of bone to withstand stress applied without violence in a rhythmical, repeated, subthreshold manner is a "stress fracture." Because numerous terms have been used in the medical literature to designate the two types of stress fractures, the following classification is recommended. A "fatigue fracture" occurs when abnormal stress is applied to bone with normal elastic resistance. An "insufficiency fracture" is produced by normal or physiological stress applied to bone with deficient elastic resistance. Fatigue and insufficiency fractures occur most frequently in the weight-bearing bones. The term "pathologic fracture" should be limited to any fracture in bone weakened by tumor.

REFERENCES

Meyerding, H.W., and Pollock, G.A.:  March Fracture , Surg Gynec Obstet 67:234-242 ( (Aug) ) 1938;.
Roberts, S.M., and Vogt, E.C.:  Pseudofracture of Tibia , J Bone Joint Surg 21:891-901 ( (Oct) ) 1939;.
Burrows, H.J.:  Fatigue Fractures of Fibula , J Bone Joint Surg 30B:266-279 ( (May) ) 1948;.
Leabhart, J.W.:  Stress Fractures of Calcaneus , J Bone Joint Surg 41A:1285-1290 ( (Oct) ) 1959;.
Burrows, H.J.:  Fatigue Infraction of Middle of Tibia in Ballet Dancers , J Bone Joint Surg 38B:83-94 ( (Feb) ) 1956;.
Devas, M.B.:  Stress Fractures of Tibia in Athletes or "Shin Soreness ," J Bone Joint Surg 40B:227-239 ( (May) ) 1958;.
Hartley, J.B.: " Stress" or "Fatigue" Fractures of Bone , Brit J Radiol 16:225-262 ( (Sept) ) 1943;.
Proctor, S.E.; Campbell, T.A.; and Dobelle, M.:  March Fractures of Tibia and Femur , Surg Gynec Obstet 78:415-418 ( (April) ) 1944;.
Miller, L.F.:  Bilateral Stress Fracture of Neck of Femur: Report of Case , J Bone Joint Surg 32A:695-697 ( (July) ) 1950;.
Selakovich, W., and Love, L.:  Stress Fractures of Pubic Ramus , J Bone Joint Surg 36A:573-576 ( (June) ) 1954;.
Evans, D.L.:  Fatigue Fractures of Ulna , J Bone Joint Surg 37B:618-621 ( (Nov) ) 1955;.
Brooke, R.:  Jive Fracture of First Rib , J Bone Joint Surg 41B:370-371 ( (May) ) 1959;.
Devas, M.B.:  Stress Fractures of Patella , J Bone Joint Surg 42B:71-74 ( (Feb) ) 1960;.
Hartley, J.B.: " Exhaustion" Fracture of Spine: Preliminary Report of One Case , Brit J Radiol 16:348-350 ( (Nov) ) 1943;.
Newman, P.H., and Stone, K.H.:  Etiology of Spondylolisthesis , J Bone Joint Surg 45B:39-59 ( (Feb) ) 1963;.
Camp, J.D., and McCullough, J.A.L.:  Pseudofractures in Diseases Affecting Skeleton System , Radiology 36:651-663 ( (June) ) 1941;.

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Meyerding, H.W., and Pollock, G.A.:  March Fracture , Surg Gynec Obstet 67:234-242 ( (Aug) ) 1938;.
Roberts, S.M., and Vogt, E.C.:  Pseudofracture of Tibia , J Bone Joint Surg 21:891-901 ( (Oct) ) 1939;.
Burrows, H.J.:  Fatigue Fractures of Fibula , J Bone Joint Surg 30B:266-279 ( (May) ) 1948;.
Leabhart, J.W.:  Stress Fractures of Calcaneus , J Bone Joint Surg 41A:1285-1290 ( (Oct) ) 1959;.
Burrows, H.J.:  Fatigue Infraction of Middle of Tibia in Ballet Dancers , J Bone Joint Surg 38B:83-94 ( (Feb) ) 1956;.
Devas, M.B.:  Stress Fractures of Tibia in Athletes or "Shin Soreness ," J Bone Joint Surg 40B:227-239 ( (May) ) 1958;.
Hartley, J.B.: " Stress" or "Fatigue" Fractures of Bone , Brit J Radiol 16:225-262 ( (Sept) ) 1943;.
Proctor, S.E.; Campbell, T.A.; and Dobelle, M.:  March Fractures of Tibia and Femur , Surg Gynec Obstet 78:415-418 ( (April) ) 1944;.
Miller, L.F.:  Bilateral Stress Fracture of Neck of Femur: Report of Case , J Bone Joint Surg 32A:695-697 ( (July) ) 1950;.
Selakovich, W., and Love, L.:  Stress Fractures of Pubic Ramus , J Bone Joint Surg 36A:573-576 ( (June) ) 1954;.
Evans, D.L.:  Fatigue Fractures of Ulna , J Bone Joint Surg 37B:618-621 ( (Nov) ) 1955;.
Brooke, R.:  Jive Fracture of First Rib , J Bone Joint Surg 41B:370-371 ( (May) ) 1959;.
Devas, M.B.:  Stress Fractures of Patella , J Bone Joint Surg 42B:71-74 ( (Feb) ) 1960;.
Hartley, J.B.: " Exhaustion" Fracture of Spine: Preliminary Report of One Case , Brit J Radiol 16:348-350 ( (Nov) ) 1943;.
Newman, P.H., and Stone, K.H.:  Etiology of Spondylolisthesis , J Bone Joint Surg 45B:39-59 ( (Feb) ) 1963;.
Camp, J.D., and McCullough, J.A.L.:  Pseudofractures in Diseases Affecting Skeleton System , Radiology 36:651-663 ( (June) ) 1941;.
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