title: Epidemiology of stress fracture injuries among US high school athletes, 2005-2006 through 2012-2013.
abstract: BACKGROUND
  High school athletes in the United States sustain millions of injuries annually, approximately 10% of which are fractures. However, there is no clear estimate of the number of stress fractures sustained by high school athletes annually despite reports that stress fractures account for 0.7% to 20% of injuries seen in sports medicine clinics. This suggests a high utilization of resources for a potentially preventable injury. In addition, stress fractures have been associated with low energy availability and disordered eating in young athletes, highlighting the importance of early recognition and intervention.
  
  
  OBJECTIVE
  To investigate stress fracture rates and patterns in a large national sample of US high school athletes.
  
  
  METHODS
  Descriptive epidemiologic study.
  
  
  METHODS
  Data from High School RIO (Reporting Information Online), a national sports injury surveillance study, were analyzed to describe rates and patterns of stress fracture injury sustained from 2005-2006 through 2012-2013, across sports and by sex.
  
  
  RESULTS
  From 2005-2006 through 2012-2013, a total of 51,773 injuries were sustained during 25,268,873 athlete-exposures, of which 389 (0.8%) were stress fractures, resulting in an overall stress fracture rate of 1.54 per 100,000 athlete-exposures. Rates per 100,000 athlete-exposures were highest in girls' cross country (10.62), girls' gymnastics (7.43), and boys' cross country (5.42). In sex-comparable sports, girls sustained more stress fractures (63.3%) than did boys (36.7%) and had higher rates of stress fracture (2.22 vs 1.27; rate ratio, 1.75; 95% CI, 1.38-2.23). The most commonly injured sites were the lower leg (40.3% of all stress fractures), foot (34.9%), and lower back/lumbar spine/pelvis (15.2%). Management was nonsurgical in 98.7% of the cases, and 65.3% of injuries resulted in ≥3 weeks of time loss, medical disqualification, or an end to the season before athletes could return to play.
  
  
  CONCLUSIONS
  Although a rare injury, stress fractures cause considerable morbidity for high school athletes of both sexes. Future research should evaluate risks of stress fractures to drive development of targeted prevention efforts.
authors.affiliation: Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA changsb@gmail.com.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Changstrom
authors.affiliation: Department of Emergency Medicine, The Children's Hospital Colorado, Aurora, Colorado, USA Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Brou
authors.affiliation: Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Morteza
authors.initials: M
authors.lastname: Khodaee
authors.affiliation: Department of Emergency Medicine, The Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Cortney
authors.initials: C
authors.lastname: Braund
authors.affiliation: Department of Epidemiology and Pediatric Injury Prevention, Education and Research (PIPER) Program, Colorado School of Public Health, Aurora, Colorado, USA.
authors.forename: R Dawn
authors.initials: RD
authors.lastname: Comstock
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005360:Fibula / Q000293:injuries; D005529:Foot Bones / Q000293:injuries; D015775:Fractures, Stress / Q000175:diagnosis / Q000453:epidemiology*; D006173:Gymnastics / Q000293:injuries; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D010384:Pelvic Bones / Q000293:injuries; D012420:Running / Q000293:injuries; D012574:Schools; D012737:Sex Factors; D013978:Tibial Fractures / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: High School RIO; epidemiology; female athletes; injury surveillance; pediatric sports medicine; stress fractures