Stress Fracture MCQ — Which of the following is NOT a common site for a stress fracture?
A) Humerus
B) Second Metatarsal
C) Tibia
D) Fibula
✅ Correct Answer: A) Humerus
💡 Short Explanation:
Stress fractures are overuse injuries caused by repetitive loading that exceeds the bone’s ability to remodel. Common sites include the tibia, second metatarsal, fibula, and navicular. The humerus is not a common site because it’s not a primary weight-bearing bone. Therefore, the correct answer is Humerus.
🦴 What is a Stress Fracture?
A stress fracture is a small crack in the bone that develops over time due to repetitive microtrauma or overuse. These injuries occur when bone resorption outpaces bone formation. They are common in athletes, runners, military recruits, and individuals who suddenly increase training intensity.
Key points:
Gradual onset of localized pain
Pain worsens with activity and may persist at rest
Common in bones subjected to repetitive impact
Often seen with training errors, poor nutrition, or biomechanical faults
⚕️ Common Sites for Stress Fractures
Tibia → most common in runners (especially anterior cortex)
Second Metatarsal → “March fracture,” classic in military and dancers
Fibula → common in jumpers and runners
Navicular → high-risk site in sprinters and jumpers
Femoral Neck → critical site needing close monitoring
Calcaneus, Sacrum → occasionally involved
Least common site:
👉 Humerus (rare, only in overhead sports like baseball, pitchin,g or military training)
🧠 Clinical Features
Gradual, focal pain
Pain increases with weight-bearing or repetitive motion
Tenderness at the fracture site
Possible swelling or mild redness
The Hop test or the tuning fork test may reproduce pain
X-ray may be normal initially; MRI is the gold standard
🧩 Diagnosis & Imaging
X-ray: often normal early; periosteal reaction later
MRI: detects early stress reactions and fractures
Bone Scan: shows increased uptake in the affected area
CT Scan: useful for cortical bone detail (e.g., navicular)
🩹 Management
Conservative Treatment (most cases):
Activity modification/rest
Protective footwear or a brace if needed
Cross-training (swimming, cycling)
Gradual return to sport once pain-free
Address underlying factors: training load, footwear, nutrition
Physiotherapy for strength, flexibility, and gait correction
Surgical Treatment:
Required in high-risk fractures (navicular, femoral neck, anterior tibial cortex)
Fixation with screws/pins if displacement or non-union risk
🏃♀️ Rehabilitation & Return to Play
Phase 1: Pain management, rest, and protected weight-bearing
Phase 2: Cross-training, maintain cardiovascular fitness
Phase 3: Gradual weight-bearing, strengthening, proprioceptive training
Phase 4: Sport-specific drills and graded return to running
Phase 5: Full participation once pain-free and strength is restored
🛡️ Prevention
Gradual increase in training intensity (≤10% per week)
Proper footwear and running surface
A balanced diet rich in calcium and vitamin D
Screening for RED-S / Female Athlete Triad
Strengthening & conditioning programs
Adequate rest between sessions
📚 Exam Relevance
Stress fracture site questions frequently appear in:
BPT / MPT exams
NPTE (USA)
PCE (Canada)
APC (Australia)
DHA / MOH / HAAD / SCFHS (Gulf exams)
AIIMS CRE / NMC / UHS (South Asia)
Common MCQ patterns include:
“Identify the site not commonly affected by stress fracture.”
“March fracture involves which bone?”
“Most common site of stress fracture in runners?”
“High-risk vs low-risk stress fracture sites”
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