Rapid Magnetic Resonance Imaging Evaluation of Femoral Neck Stress Fractures in a U.S. Active Duty Military Population

May, Lauren A.; Chen, Dillon C.; Bui-Mansfield, Liem T.; O’Brien, Seth D.

doi:10.7205/milmed-d-16-00031

Cited by 16 publications

(16 citation statements)

References 14 publications

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“…Radiographs of stress fractures are frequently normal [24, 25] therefore, MRI is paramount to identify small fracture lines and exclude other possible causes of bone and joint pain. The MRI features of a stress fractures can be nonspecific, varying from a prominent bone marrow edema with or without periosteal reaction [24, 25] to a distinct fracture line. Without the adequate clinical setting, these findings may be misinterpreted as evidence of infection or neoplasia [26–28].…”

Section: Discussionmentioning

confidence: 99%

Humeral stress fracture in a female CrossFit athlete: a case report

Godoy

Malavolta

Lundberg

et al. 2019

BMC Musculoskelet Disord

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Background Humeral stress fractures are rare injuries usually related to sports practice and joint overload without a direct trauma. A proximal humeral stress fracture has never been reported in a CrossFit athlete. Case presentation We report a stress fracture in the humerus of a 22-year-old woman after intense CrossFit training. Patient’s previous medical history included amenorrhea and reduced Vitamin D levels. The patient was treated conservatively and resumed CrossFit training after she was advised not to until follow up imaging. Conclusions We present the MRI features of the case and emphasize the difficulties in diagnosis due to multiple possible causes of shoulder pain in a CrossFit athlete and by negative findings on early radiographs. Hormonal variations, Vitamin D insufficiency and the patient’s attitude towards exercise were important factors that contributed for the stress injury after weight-lifting in CrossFit.

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Section: Discussionmentioning

confidence: 99%

Humeral stress fracture in a female CrossFit athlete: a case report

Godoy

Malavolta

Lundberg

et al. 2019

BMC Musculoskelet Disord

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“…Other novel applications include using abbreviated MRI in the pediatric population to decrease the duration of necessary sedation, and as a rapid and accurate imaging tool in the musculoskeletal setting to detect fractures and increase patient throughput in an emergency setting. [93][94][95] The above studies reflect the increasing scrutiny on the disproportionate contribution of radiology to the rising overall healthcare expenditures. As a result, value-based healthcare is the new paradigm that has quickly replaced the fee-for-service model.…”

Section: Abbreviated Mri As a Valuable Initiativementioning

confidence: 96%

“…Variable imaging protocols have been used and in general show a similar diagnostic performance compared with the full protocol for the detection of occult malignancies. Other novel applications include using abbreviated MRI in the pediatric population to decrease the duration of necessary sedation, and as a rapid and accurate imaging tool in the musculoskeletal setting to detect fractures and increase patient throughput in an emergency setting …”

Section: Abbreviated Mri As a Valuable Initiativementioning

confidence: 99%

Abbreviated MRI of the Breast: Does It Provide Value?

Leithner

Moy

Morris

et al. 2018

Magnetic Resonance Imaging

125

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“…Overuse injuries can lead to a substantial loss in training time, [1][2][3][4] increased healthcare costs, 1,3,5 and potential long-term morbidity. [6][7][8] Early identi cation and effective treatment are essential to maintaining a ready force.…”

Section: Introductionmentioning

confidence: 99%

“…6,7,21 Fast sequence hip MRI is capable of completing examinations within 10 min, as compared to normal sequence MRI which can take up to 40 minutes without contrast. 6,7 The intent of this project was to evaluate the utility of single and combined history and examination items in determining when a FNSF should be considered in the differential diagnosis of IET Soldiers with hip or groin pain, thus warranting an MRI. The goal is to improve clinical screening decisions resulting in timely diagnosis of FNSF without unnecessary imaging procedures.…”

mentioning

confidence: 99%

Attempted Development of a Clinical Decision-making Model to Assist in Femoral Neck Stress Fracture Screening in Military Trainees

Zimmerman

Deyle²,

Lester³

et al. 2020

Preprint

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Background: Femoral neck stress fractures (FNSF) are serious injuries prevalent throughout the military, particularly within the initial entry training (IET) population. Delay in diagnosis and management can lead to complications secondary to fracture progression and displacement. Effective screening and identification of FNSF can reduce patient risk, mitigate costs associated with treatment, and prevent the potential medical discharge of IET personnel. There is currently no validated testing to assist in decisions for ordering advanced imaging to rule out FNSF. Military healthcare providers, therefore, must rely on advanced imaging of patients with hip region complaints to rule out suspected FNSF resulting in potential MRI over utilization. The purpose of this project was to determine if a clinical decision model can be developed from clinical findings to assist clinicians in deciding when magnetic resonance imaging (MRI) is warranted for FNSF screening in IET personnel with hip or groin pain. Methods: This was a prospective observational cross-sectional cohort process improvement project. We screened all IET Soldiers presenting to a medical clinic with hip or groin pain and evaluated 18 clinical variables. The reference standard was a FNSF diagnosed using fast-sequence MRI. Statistical analyses included correlation, receiver operating characteristic (ROC) curve assessments, and regression.Results: Final statistical analysis included 184 IET Soldiers, of which 49 had a FNSF. Frequency analysis observed the highest occurrence of FNSF in non-Hispanic white females. Ten subjective and physical examination variables had a weak correlation to positive MRI findings for FNSF. Regression analysis revealed six variables with positive MRI outcome predictive abilities; however, small to medium effect sizes, low ability to account for MRI outcome variance, and poor estimated sensitivity on ROC curve analysis limit this regression model’s clinical usefulness utilizing the identified variables. Conclusions: The regression models evaluating the clinical variables within this project failed to demonstrate adequate predictability and clinical usefulness when screening for the high-risk injury FNSF in an IET population. Clinicians should maintain a low threshold for ordering an MRI to screen for FNSF in this population. Clinicians also cannot rely on subject-reported pain locations or objective testing as definitive assessment signs to distinguish between IET Soldiers with and without a FNSF.Trial Registration: This study was deemed as a process improvement project by the Brooke Army Medical Center Institutional Review Board on 7 August 2017. A trial registration was not needed.

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Rapid Magnetic Resonance Imaging Evaluation of Femoral Neck Stress Fractures in a U.S. Active Duty Military Population

Abstract: An abbreviated MR hip examination can diagnose femoral neck stress fractures as well as additional pathologies that explain the patient's symptoms. Femoral neck stress fractures are common in U.S. military personnel.

Cited by 16 publications

References 14 publications

Humeral stress fracture in a female CrossFit athlete: a case report

Humeral stress fracture in a female CrossFit athlete: a case report

Abbreviated MRI of the Breast: Does It Provide Value?

Attempted Development of a Clinical Decision-making Model to Assist in Femoral Neck Stress Fracture Screening in Military Trainees

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