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Stress and insufficiency fractures

J A Buckwalter1, E A Brandser

  • 1University of Iowa Hospitals and Clinics, Iowa City, USA.

American Family Physician
|July 1, 1997
PubMed
Summary

Stress fractures cause localized pain without acute injury history. Advanced imaging like MRI is often needed when initial X-rays are inconclusive for diagnosis.

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Area of Science:

  • Orthopedics
  • Radiology
  • Sports Medicine

Background:

  • Stress fractures present as localized pain without specific acute trauma.
  • Differential diagnoses include neoplasms, infections, and soft tissue injuries.
  • Plain radiographs may show fracture lines or callus, but are often normal initially.

Purpose of the Study:

  • To review the diagnostic challenges of stress fractures.
  • To highlight situations where plain radiographs are insufficient.
  • To discuss alternative imaging modalities for stress fracture detection.

Main Methods:

  • Review of literature on stress fracture diagnosis.
  • Analysis of radiographic findings in stress fractures.
  • Comparison of plain radiography with advanced imaging techniques.

Main Results:

  • Initial radiographs are frequently normal or nondiagnostic in stress fractures.
  • Normal radiographs occur early in symptom onset, in osteopenic patients, or with spinal/pelvic fractures.
  • Bone scans, CT, and MRI typically identify fractures when plain films fail.

Conclusions:

  • Stress fractures require a high index of suspicion.
  • Advanced imaging is crucial when plain radiographs are negative.
  • Early and accurate diagnosis impacts patient management and outcomes.

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