FRATTURE DA STRESS NEI TERSICOREI: PREVENZIONE E ITER DIAGNOSTICO TERAPEUTICO. ANALISI DEI FATTORI DI RISCHIO MEDIANTE QUESTIONARIO 'SELF REPORTED INJURY' E DATABASE CLINICO

STRESS FRACTURES IN BALLET DANCERS: OUR PREVENTION AND DIAGNOSTIC PROTOCOL. RISK FACTORS EVALUATION USING A SELF REPORTED INJURY QUESTIONNAIRE AND CLINICAL HISTORY DATA BASE. STUDY DESIGN: RETROSPECTIVE DESCRIPTIVE STUDY OBJECTIVE: WE PERFORMED A STUDY TO DESCRIBE OUR DIAGNOSTIC AND CLINICAL APPROACH TO STRESS FRACTURES IN ELITE YOUNG BALLET DANCERS. THE STUDY LASTED ONE DANCE ACADEMIC YEAR. MATERIAL AND METHODS: OUR POPULATION CONSISTED OF 180 BALLET DANCERS BUT ONLY 111 DANCERS WERE FINALLY ENROLLED TO THE STUDY. AT THE END OF THE ACCADEMIC YEAR EACH DANCER FILLED IN A SELF REPORTED INJURIES QUESTIONNAIRE, AND ALL CLINICAL DATA OF DANCERS MEDICAL HISTORY DURING THE SAME YEAR WERE COLLECTED. IF A STRESS FRACTURE WAS SUPPOSED DURING CLINICAL EVALUATION, A SPECIFIC PROTOCOL WAS APPLIED. THIS WAS BASED ON MRI EVALUATION AND EXTERNAL SHOCK WAVE THERAPY (ESWT) APPLICATIONS. SUSPICIOUS FACTORS OF STRESS FRACTURES WERE IDENTIFIED AND USED TO DECIDE THE TREATMENT OPTIONS. RESULTS: DESCRIPTIVE DATA REGARDING AGE, SEX, AND ANTHROPOMETRIC MEAUSEREMENTS WERE PUBLISHED IN THE ORIOGINAL WORK. 19 STRESS FRACTURES WERE OCCURRED AT METATARSAL AND TIBIAL REGION. ALL DANCERS UNDERWENT TO THREE APPLICATIONS OF ESWT. DISCUSSION: USING THE CLINICAL DATA OF THE MEDICAL HISTORY, WE IDENTIFIED SEVERAL SUSPICIOUS FACTORS FOR STRESS FRATURES. POSITIVE SIGNS DURING THE CLINICAL EVALUATION AND AT LEAST TWO SUSPICIOUS FACTORS WERE PEREMPTORY TO DECIDE TO FOLLOW THE TREATMENT WITH ESWT. ALL DANCERS WITH STRESS FRACTURES RECEIVED THREE CONSECUTIVE APPLICATIONS OF ESWT WITH GOOD RESULTS. THEN THESE DANCERS FOLLOWED A PERIOD OF ABSOLUTE REST OF 3 WEEKS (MEAN) AND A PERIOD OF RELATIVE REST OF 4 WEEKS (MEAN). DANCERS NEVER USED CASTS AND CONTINUED TO PRACTISE EXERCISE FOR ELASTICITY IN NON-WEIGHT BEARING DURING ALL THESE PERIODS. AFTER THIS, DANCERS STARTED AGAIN DANCING PROGRESSIVELY WITH A RESTORATION OF A COMPLETE DANCING ACTIVITY AFTER 1 MONTH. WE THINK THAT ESWT AND THE CORRECTION OF ANY PREDISPOSING FACTORS WERE AND ARE ACTUALLY THE GOLD STANDARD IN THE TREATMENT OF STRESS FRACTURES IN ELITE DANCERS. THE PROMPT DIAGNOSIS FOLLOWED A METICULOUS CLINICAL AND ANAMNESTIC EVALUATION. MRI IMAGES CAN HIGHLIGHT STRESS FRACTURES AND THEY SCHOULD BE PERFOMED AT THE BEGINNING OF SYMPTOMS TO START TREATMENT IN TIME. CONCLUSION: OUR DIAGNOSTIC AND TREATMENT PROTOCOL FOR STRESS FRACTURE PERMITTED A GOOD HEALING OF STRESS FRATURES IN ALL YOUNG ELITE BALLET DANCERS OF OUR STUDY GROUP.