Stress fracture of the ulna in an elite ice dancer.

Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging), and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score. Key points The technical elements in ice dancing can overload joints and bones due to the positions held by the skaters. To project a competition program as much as possible safe regarding overuse injury prevention an accurate knowledge of physiological parameters of the ice dancer and of ISU rules is necessary. Key words: Figure skating, ice dancing, overuse injury, stress fracture Introduction Stress fracture was first described by a Prussian military doctor in 1855 after observing metatarsal bone fractures in soldiers. Stress fractures account for 10% of sports injuries, with 0.7-15.6% of athletes presenting with stress fractures. In a study of 320 cases of stress fractures in athletes, it was reported that the tibia was most often involved (49%), followed by the tarsus (25.3%), the metatarsus (8.8%), the femur (7.2%), the fibula (6.6%), and the pelvis and spine (<1%) but rarely the upper extremities (Matheson, 1987). The first case of a diaphyseal ulnar fracture was reported in a worker (Kitchin, 1948). Though an uncommon injury, diaphyseal ulnar stress fracture has been reported in athletes from various sports: volleyball (Mutoh, 1982); body building (Hamilton, 1984); weight lifting (Chen, 1991); tennis (Bollen, 1993); polo (Clarks, 2002); softball (Bigosinski, 2010), break dance (Chen, 2008) and in a young recruit during honor guard training (Lin, 2012).