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April 1968

Fatigue Fractures. A Clinical Study.

Arch Intern Med. 1968;121(4):389. doi:10.1001/archinte.1968.03640040083051

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A "fatigue fracture" is defined as a process which begins "with excessive elastic deformation and recoil of bone causing an 'unraveling' of the lamellar structure of a thin segment of older circumferential bone. Subsequent local resorption of the circumferential bone is followed by replacement with osteonal bone—a normal process exerted by stress and, perhaps, mediated by electrical activity. If this acceleration is too pronounced, resorption occurs more rapidly than the replacement, causing local osteoporosis followed by callous reinforcement. If mechanical stress is too great for the unsupported osteoporotic area, a gross fracture occurs, which is similar to the fatigue fracture in inert materials."

From here the authors describe fatigue fractures of metatarsals, calcaneus, tibia, fibula, femur, pelvis, and virtually every other bone with the exception of the skull. Each area is generously illustrated with well reproduced radiographs and rare photomicrographs of bone biopsies. A concluding section discusses fatigue fractures in

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