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Occult Fracture
Fathima Fijula P. Manzil, MD; Umesh D. Oza, MD; Charlotte Myers, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Occult fracture (fx): Fracture with no obvious radiographic findings
          • High-energy trauma fx
            • Compressive forces (direct blow), traction forces (avulsion injury)
          • Fatigue fx
            • Due to repeated mechanical stress on healthy bone (e.g., athletes)
          •  Insufficiency fx
            • Due to stress on weakened bone 
            • Osteoporosis, post radiotherapy, chronic rheumatological diseases, corticosteroid therapy
          • Clinical correlation is very important

      IMAGING

      • General Features

        • Radiographic Findings

          • Nuclear Medicine Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • Staging, Grading, & Classification

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            • Image Interpretation Pearls

                              Selected References

                              1. Rogers NB et al: Improving the diagnosis of ipsilateral femoral neck and shaft fractures: a new imaging protocol. J Bone Joint Surg Am. ePub, 2019
                              2. Scheyerer MJ et al: Evaluation of pelvic ring injuries using SPECT/CT. Skeletal Radiol. ePub, 2014
                              3. Querellou S et al: Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med. Epub ahead of print, 2013
                              4. Allainmat L et al: Use of hybrid SPECT/CT for diagnosis of radiographic occult fractures of the wrist. Clin Nucl Med. 38(6):e246-51, 2013
                              5. Cannon J et al: Imaging choices in occult hip fracture. J Emerg Med. 37(2):144-52, 2009
                              6. Bryant LR et al: Comparison of planar scintigraphy alone and with SPECT for the initial evaluation of femoral neck stress fracture. AJR Am J Roentgenol. 191(4):1010-5, 2008
                              7. Wu PS et al: Clinical significance of solitary rib hot spots on bone scans in patients with extraskeletal cancer: correlation with other clinical manifestations. Clin Nucl Med. 27(8):567-71, 2002
                              8. Donohoe KJ et al: Procedure guideline for bone scintigraphy: 1.0. Society of Nuclear Medicine. J Nucl Med. 37(11):1903-6, 1996
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  TERMINOLOGY

                                  • Definitions

                                    • Occult fracture (fx): Fracture with no obvious radiographic findings
                                      • High-energy trauma fx
                                        • Compressive forces (direct blow), traction forces (avulsion injury)
                                      • Fatigue fx
                                        • Due to repeated mechanical stress on healthy bone (e.g., athletes)
                                      •  Insufficiency fx
                                        • Due to stress on weakened bone 
                                        • Osteoporosis, post radiotherapy, chronic rheumatological diseases, corticosteroid therapy
                                      • Clinical correlation is very important

                                  IMAGING

                                  • General Features

                                    • Radiographic Findings

                                      • Nuclear Medicine Findings

                                        • Imaging Recommendations

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • Staging, Grading, & Classification

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Demographics

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      DIAGNOSTIC CHECKLIST

                                                      • Consider

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Rogers NB et al: Improving the diagnosis of ipsilateral femoral neck and shaft fractures: a new imaging protocol. J Bone Joint Surg Am. ePub, 2019
                                                          2. Scheyerer MJ et al: Evaluation of pelvic ring injuries using SPECT/CT. Skeletal Radiol. ePub, 2014
                                                          3. Querellou S et al: Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med. Epub ahead of print, 2013
                                                          4. Allainmat L et al: Use of hybrid SPECT/CT for diagnosis of radiographic occult fractures of the wrist. Clin Nucl Med. 38(6):e246-51, 2013
                                                          5. Cannon J et al: Imaging choices in occult hip fracture. J Emerg Med. 37(2):144-52, 2009
                                                          6. Bryant LR et al: Comparison of planar scintigraphy alone and with SPECT for the initial evaluation of femoral neck stress fracture. AJR Am J Roentgenol. 191(4):1010-5, 2008
                                                          7. Wu PS et al: Clinical significance of solitary rib hot spots on bone scans in patients with extraskeletal cancer: correlation with other clinical manifestations. Clin Nucl Med. 27(8):567-71, 2002
                                                          8. Donohoe KJ et al: Procedure guideline for bone scintigraphy: 1.0. Society of Nuclear Medicine. J Nucl Med. 37(11):1903-6, 1996