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Progression of stress to full thickness fracture

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Pain over the lateral ankle for some time. No history of trauma. Recent worsening of pain.

Patient Data

Age: 50 years
Gender: Female

Subtle transverse band of sclerosis in the distal fibula with overlying soft tissue swelling.

The patient continued weight-bearing. A repeat x-ray was performed four weeks later due to worsening pain. 

Four weeks later

x-ray

Subsequent x-ray shows full thickness fracture with displacement and subtle periosteal new bone formation. Note lucency of bone distal to the fracture line.

Case Discussion

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.

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