Abstract
OBJECTIVE: This study aimed to investigate the epidemiological characteristics and anatomical distribution of stress fractures (SFs) in a pediatric and adolescent population over an eight-year period. METHODS: We conducted a retrospective cohort study at a tertiary care orthopedic center. We reviewed medical records and imaging data for patients aged 6-18 years who were diagnosed with SFs between January 2017 and December 2024. Patients were assigned to age groups of 6-11, 12-15, and 16-18 years. We collected demographic data, fracture location, and annual consultation-based rates. Statistical analyses were performed using SPSS 26.0 and R software for trend analysis. RESULTS: A total of 726 patients (403 males, 323 females; median age 14 years, IQR 12-15) were included. The overall consultation-based rate was 23.20 per 100,000 unique pediatric orthopedic patients. Cases were concentrated in the 12-15 years age group, which accounted for 78.24%. The tibia was the most commonly involved bone (83.06%), and the proximal tibia was the single most frequent site (48.62%). Annual rates rose from 8.09 per 100,000 in 2017 to a peak of 38.98 in 2022, then declined to 23.98 in 2024(Poisson regression for linear trend, P < 0.001). Male patients had a higher proportion of proximal tibia fractures, whereas female patients had more mid- to distal-tibia fractures (P < 0.01). CONCLUSIONS: SFs predominantly affected adolescent males, and the proximal tibia was the most vulnerable site. The observed rise-and-fall trend temporally coincided with shifts in educational and physical activity policies in China, although causal inference was limited by the ecological study design. These descriptive findings emphasized the need for prospective studies that incorporate exposure and risk-factor assessment to inform targeted prevention strategies.