Unusual exercise-related stress fractures. Two case reports

Area of Science:

• Orthopedics
• Sports Medicine
• Radiology

Background:

• Stress fractures are common overuse injuries, typically affecting weight-bearing bones.
• Unusual locations and presentations of stress fractures can pose diagnostic challenges.
• Scintigraphy, particularly delayed bone scans, is a sensitive tool for detecting bone abnormalities.

Purpose of the Study:

• To report two rare cases of exercise-related stress fractures in unusual anatomical locations.
• To highlight the utility of delayed bone scintigraphy in diagnosing these uncommon injuries.
• To document previously undescribed scintigraphic findings of stress fractures.

Main Methods:

• Case report of two patients presenting with exercise-induced pain.
• Diagnostic imaging utilizing a 2-hour delay bone scan (scintigraphy).
• Review of literature for previously reported cases of stress fractures in similar locations.

Main Results:

• A stress fracture of the sacroiliac joint was identified in a long-distance runner.
• Bilateral stress fractures of the scapular body were diagnosed in an above-knee amputee.
• Both fractures were detected using delayed bone scintigraphy, with no prior scintigraphic reports found for these specific injuries.

Conclusions:

• The sacroiliac joint and scapula are rare but possible sites for exercise-related stress fractures.
• Delayed bone scintigraphy is effective in diagnosing these uncommon stress fractures.
• The bilateral scapular fracture represents a novel, unreported entity in the literature.