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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
- Stress fracture: Fatigue fracture, insufficiency fracture, march fracture, exhaustion fracture, crack fracture, pseudofracture
- Chronic repetitive physeal injury: Traction apophysitis, little leaguer elbow, little leaguer shoulder, gymnast wrist
Definitions
- Fatigue fracture: Fracture due to abnormal stresses applied (over time) to normal bone
- Normal bone subjected to repetitive stresses that in isolation would not lead to fracture but gradually result in mechanical failure
- Insufficiency fracture: Fracture due to normal stresses applied to abnormal bone
- Demineralized or otherwise weakened bone from focal or systemic process
- Osteoporosis, osteogenesis imperfecta, rickets/osteomalacia, hyperparathyroidism
- Pathologic fracture: Underlying lesion weakens bone, predisposing to fracture
- Demineralized or otherwise weakened bone from focal or systemic process
- Stress response/reaction: Result of stresses upon bone prior to development of macroscopic fracture
- Microtrabecular fracture + some degree of healing
- Chronic physeal stress injury: Repetitive stress to metaphyseal vasculature & cartilaginous growth plate interrupts normal endochondral ossification
- Fatigue fracture: Fracture due to abnormal stresses applied (over time) to normal bone
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Boyle MJ et al: Femoral neck stress fractures in children younger than 10 years of age. J Pediatr Orthop. ePub, 2016
- Bedoya MA et al: Overuse injuries in children. Top Magn Reson Imaging. 24(2):67-81, 2015
- Swischuk LE et al: Tibial stress phenomena and fractures: imaging evaluation. Emerg Radiol. 21(2):173-7, 2014
- Rauck RC et al: Pediatric upper extremity stress injuries. Curr Opin Pediatr. 25(1):40-5, 2013
- Jaimes C et al: Taking the stress out of evaluating stress injuries in children. Radiographics. 32(2):537-55, 2012
- Galbraith RM et al: Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2(3):127-33, 2009
- Hébert KJ et al: MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 190(6):1487-91, 2008
- Laor T et al: Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol. 186(5):1260-4, 2006
- Lee SH et al: Stress fractures of the femoral diaphysis in children: a report of 5 cases and review of literature. J Pediatr Orthop. 25(6):734-8, 2005
- Ahovuo JA et al: Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol. 14(3):500-5, 2004
- Biedert R et al: Stress fractures of the medial great toe sesamoids in athletes. Foot Ankle Int. 24(2):137-41, 2003
- Craig JG et al: Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen. Skeletal Radiol. 32(1):22-7, 2003
- Iwamoto J et al: Stress fractures in athletes: review of 196 cases. J Orthop Sci. 8(3):273-8, 2003
- Parr TJ et al: Overuse injuries of the olecranon in adolescents. Orthopedics. 26(11):1143-6, 2003
- Ishibashi Y et al: Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med. 12(2):79-84, 2002
- Laor T et al: Local physeal widening on MR imaging: an incidental finding suggesting prior metaphyseal insult. Pediatr Radiol. 27(8):654-62, 1997
- Umans HR et al: Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging. Skeletal Radiol. 25(4):319-24, 1996
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Synonyms
- Stress fracture: Fatigue fracture, insufficiency fracture, march fracture, exhaustion fracture, crack fracture, pseudofracture
- Chronic repetitive physeal injury: Traction apophysitis, little leaguer elbow, little leaguer shoulder, gymnast wrist
Definitions
- Fatigue fracture: Fracture due to abnormal stresses applied (over time) to normal bone
- Normal bone subjected to repetitive stresses that in isolation would not lead to fracture but gradually result in mechanical failure
- Insufficiency fracture: Fracture due to normal stresses applied to abnormal bone
- Demineralized or otherwise weakened bone from focal or systemic process
- Osteoporosis, osteogenesis imperfecta, rickets/osteomalacia, hyperparathyroidism
- Pathologic fracture: Underlying lesion weakens bone, predisposing to fracture
- Demineralized or otherwise weakened bone from focal or systemic process
- Stress response/reaction: Result of stresses upon bone prior to development of macroscopic fracture
- Microtrabecular fracture + some degree of healing
- Chronic physeal stress injury: Repetitive stress to metaphyseal vasculature & cartilaginous growth plate interrupts normal endochondral ossification
- Fatigue fracture: Fracture due to abnormal stresses applied (over time) to normal bone
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Boyle MJ et al: Femoral neck stress fractures in children younger than 10 years of age. J Pediatr Orthop. ePub, 2016
- Bedoya MA et al: Overuse injuries in children. Top Magn Reson Imaging. 24(2):67-81, 2015
- Swischuk LE et al: Tibial stress phenomena and fractures: imaging evaluation. Emerg Radiol. 21(2):173-7, 2014
- Rauck RC et al: Pediatric upper extremity stress injuries. Curr Opin Pediatr. 25(1):40-5, 2013
- Jaimes C et al: Taking the stress out of evaluating stress injuries in children. Radiographics. 32(2):537-55, 2012
- Galbraith RM et al: Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2(3):127-33, 2009
- Hébert KJ et al: MRI appearance of chronic stress injury of the iliac crest apophysis in adolescent athletes. AJR Am J Roentgenol. 190(6):1487-91, 2008
- Laor T et al: Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol. 186(5):1260-4, 2006
- Lee SH et al: Stress fractures of the femoral diaphysis in children: a report of 5 cases and review of literature. J Pediatr Orthop. 25(6):734-8, 2005
- Ahovuo JA et al: Fatigue stress fractures of the sacrum: diagnosis with MR imaging. Eur Radiol. 14(3):500-5, 2004
- Biedert R et al: Stress fractures of the medial great toe sesamoids in athletes. Foot Ankle Int. 24(2):137-41, 2003
- Craig JG et al: Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen. Skeletal Radiol. 32(1):22-7, 2003
- Iwamoto J et al: Stress fractures in athletes: review of 196 cases. J Orthop Sci. 8(3):273-8, 2003
- Parr TJ et al: Overuse injuries of the olecranon in adolescents. Orthopedics. 26(11):1143-6, 2003
- Ishibashi Y et al: Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med. 12(2):79-84, 2002
- Laor T et al: Local physeal widening on MR imaging: an incidental finding suggesting prior metaphyseal insult. Pediatr Radiol. 27(8):654-62, 1997
- Umans HR et al: Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging. Skeletal Radiol. 25(4):319-24, 1996
