Plain radiograph
Musculoskeletal system
Case TypeClinical Cases
Authors
JC. Le Van An, P.Parva, F. Rety
Patient46 years, female
The patient had developed pain along the anterior aspect of her right tibia over several weeks.
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.
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.
[1] Murcia M, Brennan RE, Edeiken J. Computed tomography of stress fracture. Skeletal Radiol 1982;8(3):193-5. (PMID: 7112145)
[2] Shearman CM, Brandser EA, Parman LM, el-Khoury GY, Saltzman CL, Pyevich MT, Boles CA. Longitudinal tibial stress fractures: a report of eight cases and review of the literature. J Comput Assist Tomogr 1998;22(2):265-9. (PMID: 9530392)
[3] Connolly LP, Connolly SA, Treves ST. Differentiation of anterior tibial stress fracture from osteoid osteoma. Clin Nucl Med 2001;26(1):54-6. (PMID: 11139055)
URL: | https://www.eurorad.org/case/1545 |
DOI: | 10.1594/EURORAD/CASE.1545 |
ISSN: | 1563-4086 |