Longitudinal Tibial Stress Fractures: A Report of Eight Cases and Review of the Literature

Shearman, Christine M.; Brandser, Eric A.; Parman, Linda M.; El‐Khoury, Georges Y.; Saltzman, Charles L.; Pyevich, Michael; Boles, Carol A.

doi:10.1097/00004728-199803000-00020

Cited by 32 publications

(16 citation statements)

References 16 publications

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“…To our knowledge, however, no previous study in which CT and MR imaging findings were evaluated in patients with early stress injuries exists in the literature (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

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CT and MR Imaging Findings in Athletes with Early Tibial Stress Injuries: Comparison with Bone Scintigraphy Findings and Emphasis on Cortical Abnormalities

Gaeta¹,

Minutoli²,

Scribano³

et al. 2005

Radiology

277

178

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Section: Discussionmentioning

confidence: 99%

“…However, CT was used to depict more lesions than did MR imaging (Table 4). MR imaging allows depiction of periosteal and endosteal marrow edema, which are believed to be useful ancillary markers for stress injury (10,19,37). Both T2-weighted images and STIR images are reliable in revealing the presence of cortical stress injury.…”

Section: Discussionmentioning

confidence: 99%

CT and MR Imaging Findings in Athletes with Early Tibial Stress Injuries: Comparison with Bone Scintigraphy Findings and Emphasis on Cortical Abnormalities

Gaeta¹,

Minutoli²,

Scribano³

et al. 2005

Radiology

277

178

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show abstract

“…In the original description of this entity [10], five of the six cases involved the tibia; the sixth case involved the femur. There have since been numerous additional reports of longitudinal stress fractures involving the tibia or femur [7,8,11,12,19,20,22,23]. To our knowledge, this is the first reported case of a longitudinal stress fracture occurring in the upper extremity.…”

Section: Discussionmentioning

confidence: 65%

Case Report: Longitudinal Stress Fracture of the Humerus: Imaging Features and Pitfalls

McMahon

Shetty

Anderson

et al. 2009

Clin Orthop Relat Res

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Longitudinal stress fractures are an uncommon injury in which a diaphyseal fracture line occurs parallel to the long axis of a bone in the absence of direct trauma. They have been described in the tibia and less commonly in the femur but apparently not in the upper limb. We report a longitudinal stress fracture occurring in the humerus of a 62-year-old woman who had a history of osteoporosis and had undergone recent surgery of the contralateral wrist. We present the radiographic, MRI, and CT features of the case and emphasize the difficulties in diagnosis caused by negative findings on early radiographs and by nonspecific bone marrow edema pattern on MRI. The risk of a contralateral upper extremity stress fracture from activities of daily living in a patient with osteoporosis whose other upper extremity is immobilized also is highlighted.

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“…48 The poor sensitivity related to early bony changes associated with stress fracture results in films being read as normal for up to 1 to 3 weeks following the onset of pain complaints. 8,17,47,54 Our patient's initial hip films were taken within this 1-to 3-week window where films may miss a stress fracture. Bone scintigraphy (scan) is often ordered when osseous lesions, such as stress fractures, are suspected because of the high sensitivity in detecting early bony changes 22,41,43,47 and abnormalities within 6 to 72 hours post onset of pain complaints.…”

Section: Discussionmentioning

confidence: 99%

“…However, making a specific diagnosis is often impossible based on bone scan alone due to poor specificity. 47,54 This lack of specificity was demonstrated by Shin et al, 55 who found that, when evaluating 22 patients with hip pain, scintigraphy had an accuracy of 68% (32% false positives) in diagnosis of femoral neck stress fractures, compared to 100% accuracy for MRI. MRI is considered by many to be the gold standard for diagnosing stress fractures, depicting a decreased (low) signal intensity of the fracture line on T1 weighted images and an increased (high) signal intensity in T2 weighted images.…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Gurney

Boissonnault²,

Andrews³

2006

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: Identifying stress fractures of the hip can be a challenging differential diagnosis. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. Hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. Diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. Discussion: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity. J Orthop Sports Phys Ther 2006;36:80-88.

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Longitudinal Tibial Stress Fractures: A Report of Eight Cases and Review of the Literature

Abstract: Longitudinal stress fractures have characteristic imaging features, and familiarity with these features is necessary for timely and efficient diagnosis, avoiding morbidity due to delay or use of unnecessary tests.

Cited by 32 publications

References 16 publications

CT and MR Imaging Findings in Athletes with Early Tibial Stress Injuries: Comparison with Bone Scintigraphy Findings and Emphasis on Cortical Abnormalities

CT and MR Imaging Findings in Athletes with Early Tibial Stress Injuries: Comparison with Bone Scintigraphy Findings and Emphasis on Cortical Abnormalities

Case Report: Longitudinal Stress Fracture of the Humerus: Imaging Features and Pitfalls

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

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