Stress fracture
Updates to Article Attributes
Stress fractures refer to fractures occurring in bone due to a mismatch of bone strength and chronic mechanical stress placed upon the bone. Fractures can either be:
- fatigue fracture: abnormal stresses on normal bone
- insufficiency fracture: normal stresses on abnormal bone
Terminology
A pathological fracture, although a type of insufficiency fracture, is a term in general reserved to fractures occurring at the site of a focal bony abnormality.
Some authors use the term stress fracture synonymously with fatigue fractures, and thus some caution with the term is suggested.
Clinical presentation
Stress fractures normally present with worsening pain with a history of minimal or no trauma. In the lower (weight bearing) limb, there is often a history of recent increase of physical activity or significant alteration in the the type or duration of normal athletic activity.
Pathology
Location
Stress fractures are far more common in the bones of the lower limb than the upper limb. Classic sites for stress fractures include:
- metatarsal shafts: especially 2nd and 3rd metatarsals
- inferomedial femoral neck
- calcaneal posterior tuberosity
- talus
- navicular
- fibula
- sesamoids: especially the hallux sesamoids
Imaging
Plain radiograph
The fracture, being typically subacute, is evident as sclerosis with or without periosteal reaction.
Radioisotope scan
Th fracture is represented as a focus of increased radio-isotope activity ( 'hot spot' ) due to increased bone turnover at the site of new bone formation.
CT
The appearances are similar to those on plain radiograph with sclerosis, new bone formation and periosteal reaction.
MRI
The fracture line is elucidated along with bone oedema in the surrounding marrow.
-</ul>- +</ul><h4>Imaging</h4><h5>Plain radiograph</h5><p>The fracture, being typically subacute, is evident as sclerosis with or without periosteal reaction.</p><h5>Radioisotope scan</h5><p>Th fracture is represented as a focus of increased radio-isotope activity ( 'hot spot' ) due to increased bone turnover at the site of new bone formation.</p><h5>CT</h5><p>The appearances are similar to those on plain radiograph with sclerosis, new bone formation and periosteal reaction.</p><p>MRI</p><p>The fracture line is elucidated along with bone oedema in the surrounding marrow. </p>