Tibial stress phenomena and fractures: imaging evaluation

This study aims to evaluate the various imaging modalities used to diagnose tibial stress-fractures/phenomena and determine which of these are most useful and definitive. The plain film, computed tomography (CT), magnetic resonance (MR), and nuclear medicine findings in a 20-patient cohort, ranging from ages 10 to 21 years with an average of 16 years, were reviewed. The male to female ratio was recorded as was the incidence of right or left, or bilateral extremity involvement. Thereafter, each imaging modality was evaluated for positive findings. Twelve of the patients had pretibial swelling on plain films, 10 a thickened cortex, to a visible fracture on plain films and 13 had increased short-tau inversion recovery (STIR) signal in the post tibial (marrow) and pretibial (subperiosteum) areas on MR imaging. No CT studies were performed. One positive nuclear medicine study was available. Although there are a number of imaging modalities which can be used to evaluate the tibial stress/fracture phenomena problem, it would appear that plain films and MR studies are most useful. If plain films do not show a fracture and further information is required, an MR study is most appropriate.