Progression of stress to full thickness fracture
Pain over the lateral ankle for some time. No history of trauma. Recent worsening of pain.
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Subtle transverse band of sclerosis in the distal fibula with overlying soft tissue swelling on the original imaging. Patient continued weight-bearing. Subsequent x-ray shows full thickness fracture with displacement and subtle periosteal new bone formation. Note lucency of bone distal to the fracture line.
Stress fractures represent defects in normal bone due to excessive forces and are often not full thickness or just cracks. If those forces are not reduced then full thickness fracture can result as in this case.