Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Section 8 Thigh
- Section 9 Leg
- Case 56 Intraneural ganglion cyst of the peroneal nerve
- Case 57 Tibial bowing: intrauterine deformation versus neurofibromatosis
- Case 58 Osteofibrous dysplasia and other cystic lesions of the anterior tibial cortex
- Case 59 Less common stress fractures of the tibia and fibula
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Case 59 - Less common stress fractures of the tibia and fibula
from Section 9 - Leg
Published online by Cambridge University Press: 05 July 2013
- Frontmatter
- Contents
- List of contributors
- Foreword
- Preface
- Section 1 Shoulder
- Section 2 Arm
- Section 3 Elbow
- Section 4 Forearm
- Section 5 Wrist
- Section 6 Hand
- Section 7 Hip and Pelvis
- Section 8 Thigh
- Section 9 Leg
- Case 56 Intraneural ganglion cyst of the peroneal nerve
- Case 57 Tibial bowing: intrauterine deformation versus neurofibromatosis
- Case 58 Osteofibrous dysplasia and other cystic lesions of the anterior tibial cortex
- Case 59 Less common stress fractures of the tibia and fibula
- Section 10 Ankle
- Section 11 Foot
- Section 12 Tumors/Miscellaneous
- Index
- References
Summary
Imaging description
Stress fractures affect most frequently tibia and rarely fibula. When the fibula is involved, stress fractures affect the distal 1/3 and very rarely proximal 1/3. Radiographic findings of the stress fractures of the fibula may be identical to the stress fractures occurring to other common locations, which include a focal periosteal reaction (Figure 59.1), a focal cortical thickening, and a band of sclerosis. Focal cortical thickening may be associated with a lucent line (black line) perpendicular to the cortex. Longitudinal stress fractures are uncommon, usually occurring in the tibia. Radiography may show irregular cortical thickening and medullary sclerosis in a longitudinal fashion (Figure 59.2A). Axial images of CT (Figure 59.2B) demonstrate a cortical disruption (fracture) at multiple slices. Coronal images of CT and MRI (Figure 59.2C) or planer images of bone scan may better delineate its longitudinal extension.
Importance
Sensitivity of radiography for stress fractures is suboptimal. The diagnosis of stress fracture can be made clinically with pertinent clinical history even with negative radiographs. The diagnosis may be challenging with atypical clinical presentations, uncommon locations, and atypical imaging findings. Imaging findings may be misinterpreted as more aggressive lesions, particularly infection or tumor. Familiarity of these uncommon presentations of stress fractures is important to avoid unnecessary biopsy and to reach a correct diagnosis.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Musculoskeletal ImagingVariants and Other Difficult Diagnoses, pp. 125 - 127Publisher: Cambridge University PressPrint publication year: 2013