Stress fracture: Abnormal stress or overuse imposed on otherwise normal bone
Stress reaction in bone leading to fracture
Skeletal trauma secondary to repetitive loading overcoming intrinsic repair rates → progressive bone disruption ranging from microdamage stress reaction to complete fracture
Stress fracture differs from insufficiency fracture: Physiologic stress overwhelming abnormal (insufficient) bone
Underlying metabolic or other bony deficiency
Partial or complete fracture
Grade I: < 25% of cortex
Grade II: 25-50% cortical involvement
Grade III: 50-75% cortical involvement
Grade IV: > 75% cortical involvement
IMAGING
General Features
Nuclear Medicine Findings
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
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
Bancroft LW: Wrist injuries: a comparison between high- and low-impact sports. Radiol Clin North Am. 51(2):299-311, 2013
Liong SY et al: Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 85(1016):1148-56, 2012
Murthy NS: Imaging of stress fractures of the spine. Radiol Clin North Am. 50(4):799-821, 2012
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
Campbell SE et al: Imaging of stress injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):62-71, 2008
Berger FH et al: Stress fractures in the lower extremity The importance of increasing awareness amongst radiologists. Eur J Radiol. 62(1):16-26, 2007
Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
Tins B et al: Marrow changes in anorexia nervosa masking the presence of stress fractures on MR imaging. Skeletal Radiol. 35(11):857-60, 2006
Fayad LM et al: Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol. 185(4):915-24, 2005
Gaeta M et al: CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology. 235(2):553-61, 2005
Connolly LP et al: Young athletes with low back pain: skeletal scintigraphy of conditions other than pars interarticularis stress. Clin Nucl Med. 29(11):689-93, 2004
Oza UD et al: Multiple insufficiency fractures in a young woman with anorexia nervosa and bulimia. Clin Nucl Med. 28(3):250-1, 2003
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References
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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
Scanning Tips
TERMINOLOGY
Definitions
Stress fracture: Abnormal stress or overuse imposed on otherwise normal bone
Stress reaction in bone leading to fracture
Skeletal trauma secondary to repetitive loading overcoming intrinsic repair rates → progressive bone disruption ranging from microdamage stress reaction to complete fracture
Stress fracture differs from insufficiency fracture: Physiologic stress overwhelming abnormal (insufficient) bone
Underlying metabolic or other bony deficiency
Partial or complete fracture
Grade I: < 25% of cortex
Grade II: 25-50% cortical involvement
Grade III: 50-75% cortical involvement
Grade IV: > 75% cortical involvement
IMAGING
General Features
Nuclear Medicine Findings
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
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
Bancroft LW: Wrist injuries: a comparison between high- and low-impact sports. Radiol Clin North Am. 51(2):299-311, 2013
Liong SY et al: Lower extremity and pelvic stress fractures in athletes. Br J Radiol. 85(1016):1148-56, 2012
Murthy NS: Imaging of stress fractures of the spine. Radiol Clin North Am. 50(4):799-821, 2012
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
Campbell SE et al: Imaging of stress injuries of the pelvis. Semin Musculoskelet Radiol. 12(1):62-71, 2008
Berger FH et al: Stress fractures in the lower extremity The importance of increasing awareness amongst radiologists. Eur J Radiol. 62(1):16-26, 2007
Lee E et al: Role of radionuclide imaging in the orthopedic patient. Orthop Clin North Am. 37(3):485-501, viii, 2006
Tins B et al: Marrow changes in anorexia nervosa masking the presence of stress fractures on MR imaging. Skeletal Radiol. 35(11):857-60, 2006
Fayad LM et al: Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol. 185(4):915-24, 2005
Gaeta M et al: CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology. 235(2):553-61, 2005
Connolly LP et al: Young athletes with low back pain: skeletal scintigraphy of conditions other than pars interarticularis stress. Clin Nucl Med. 29(11):689-93, 2004
Oza UD et al: Multiple insufficiency fractures in a young woman with anorexia nervosa and bulimia. Clin Nucl Med. 28(3):250-1, 2003
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