Research Update on Stress Riser Fractures
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REVIEW ARTICLE
Research Update on Stress Riser Fractures Jehyun Yoo1 · Xiao Ma2 · Jonghwa Lee2 · Jihyo Hwang2 Received: 27 February 2020 / Accepted: 12 October 2020 © Indian Orthopaedics Association 2020
Abstract Stress fractures are fatigue-induced fractures which are caused by repetitive force, often from overuse. They are well-established and frequently encountered in the field of orthopedics. Stress fractures occur in the bone because of low-bone strength and high chronic mechanical stress placed on the bone. Stress riser fractures are also stress fractures that occur because of the presence of cortical defects (holes), changes in stiffness, sharp corners, and cracks (fracture lines). Periprosthetic or periimplant fractures are good examples of stress riser fractures that occur in regions where stress forces are higher than those in the surrounding material. Most stress riser fractures are related to technical errors (iatrogenic causes) and are difficult to manage. It is possible and more effective to prevent the creation of stress riser fractures through better surgical techniques. The proper terminology for stress fractures, stress riser fractures, periprosthetic fractures, peri-implant fractures, interprosthetic fractures, and interimplant fractures is discussed. This review of the current state of knowledge, diagnosis, treatment, and prevention of stress riser fractures is based on clinical evidence and recent literature. Keywords Stress fracture · Stress riser fracture · Periprosthetic fracture · Peri-implant fracture · Interprosthetic fracture · Interimplant fracture
Introduction Stress fractures are well known in the field of orthopedics and were originally discovered in military recruits and athletes. By convention, stress fractures are caused by accumulated trauma with repeated submaximal loading from running or jumping. The first description of stress fractures dates back a 100 years. Rib fractures due to chronic cough were first described by Gooch in 1733 [1]. Stress riser fractures are a type of stress fracture caused by a concentration of stress in localized regions of the cortical bone and can cause catastrophic failures rather than stress fractures. Therefore, stress riser fractures are more iatrogenic than stress fractures. Stress concentration is a well-established concept in the field of engineering. Metal
* Jihyo Hwang [email protected] 1
Department of Orthopaedic Surgery, Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Republic of Korea
Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
2
fatigue and cracks at the corners of aircraft windows or ship hatches are classic examples of what happens because of stress concentration. When stress risers experience fatigue, torsional, or tension forces, fractures may occur at the area of stress concentration. The empty hole remaining after the removal of an implant is a typical example of stress concentration in the field of orthop
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