In this review of prospectively collected data, representing the largest series of its kind, we identified 25 stress
injuries of the diaphyseal femur in 20 athletes at an NCAA (National Collegiate Athletic Association) Division I university. All 20 patients successfully completed rehabilitation and returned to activity without limitations. Seventeen of these patients (representing 22
injuries) were female, and all 5 patients who sustained 2 stress
injuries were female. The higher proportion of injured females in this study, and the histories of
menstrual irregularities and disordered eating, raised the concern that the
female athlete triad may be
a factor. It is important to consider the diagnosis of stress
injuries of the diaphyseal femur when evaluating thigh
pain in running athletes, especially females, as early diagnosis and treatment lead to excellent outcomes and full return to activity. Magnetic resonance imaging should be considered the gold standard in the diagnostic evaluation of these
injuries. Further, as
stress fractures may be the first presentation of the
female athlete triad, it is also important for orthopedic surgeons to identify the presence of risk factors that may predispose athletes to recurrent stress
injuries and other health problems.