CASE 1545 Published on 21.05.2002

Stress fracture of the tibia

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

JC. Le Van An, P.Parva, F. Rety

Patient

46 years, female

Categories
No Area of Interest ; Imaging Technique Nuclear medicine conventional, CT
Clinical History

The patient had developed pain along the anterior aspect of her right tibia over several weeks.

Imaging Findings

The patient had developed pain along the anterior aspect of her right tibia over several weeks. An initial plain radiograph was unremarkable.

A bone scintigraphy scan was performed and showed localised increased isotope uptake in the right tibial diaphysis.

Bone scintigraphy was followed up by computed tomography. CT of the right lower extremity demonstrated a longitudinally oriented fracture line with associated endosteal and periosteal callus formation.

Discussion

Stress fracture has been defined as partial or incomplete fracture of bone due to the inability of the bone to withstand non-violent stress that is applied in a rhythmic sub-threshold manner. Stress fractures of the tibia less commonly involve the anterior than the posterior diaphysis. The diagnosis of a stress fracture is usually made from history and clinical examination. Pain is the main symptom and characteristically it is relieved by rest and recurs with activity. Longitudinal stress fractures are less common than the transverse variety and clinical presentation could be atypical.

Plain films are frequently negative at the time of presentation. When positive, plain film findings include a longitudinal linear lucency, cortical thickening, and periosteal or endosteal reaction. Bone scintigraphy reveals localised increased isotope uptake at the site of stress fractures. CT demonstrates a lucent linear cortical breach on serial axial images with surrounding endosteal and periosteal sclerosis. The MR appearance of stess fracture is a band-like area of low intensity on all pulse sequences, contiguous with the cortex, and oedema within the marrow surrounding this low band with increased signal intensity on T2-weighted images and decreased intensity on T1-weighted images.

Differential Diagnosis List
Stress fracture of the tibia
Final Diagnosis
Stress fracture of the tibia
Case information
URL: https://www.eurorad.org/case/1545
DOI: 10.1594/EURORAD/CASE.1545
ISSN: 1563-4086