Review of imaging findings of stress fractures of pelvis and lower extremities

Congress:

ESSR 2015

Poster Number:

P-0012

Type:

Educational Poster

Keywords:

Bones, Extremities, Musculoskeletal system, MR, Plain radiographic studies, CT, Education, Athletic injuries, Osteoporosis

Authors:

E. Tavernaraki¹, V. Bizimi¹, V. Vantali¹, V. Papalouka², D. Chondros¹, O. Papakonstantinou¹; ¹Athens/GR, ²Chaidari/GR

DOI:

10.1594/essr2015/P-0012

DOI-Link:

https://dx.doi.org/10.1594/essr2015/P-0012

$Fig. 25: Calcaneal stress fracture.$

Fig. 25: Calcaneal stress fracture.

$Fig. 26: Calcaneal stress fracture.$

Fig. 26: Calcaneal stress fracture.

$Fig. 21: Multiple pelvic ring insufficiency fractures.$

Fig. 21: Multiple pelvic ring insufficiency fractures.

$Fig. 22: Multiple pelvic ring insufficiency fractures.$

Fig. 22: Multiple pelvic ring insufficiency fractures.

Learning objectives

-Recognize radiographic signs of stress fractures of lower extremities and pelvis. -Recognize MRI signs of stress fractures of lower extremities and pelvis.

Background

Stress fractures are overuse injuries as the result of repetitive load in healthy bones (fatigue fractures) or in abnormal bone (insufficiency fractures).It is a result of imbalance between osteoblast and osteoclasts due to <<remodeling>> of repetitive <<stress>> in bone. Insufficiency fractures are generally seen in elderly and more frequently in women, in the setting of osteoporosis. Common locations include vertebra, sacrum, neck of femur, pubic rami. Causes are osteoporosis, radiation, steroids , hyperparathyroidism, rheumatoid arthritis, osteomalakia, Diabetes, Paget, Osteogenesis Imperfecta and tumor. Fatigue fractures are...

Imaging findings OR Procedure Details

Radiography: In acute phase radiography may be negative, in subacute and chronic phase they may be misdiagnosed as cases of malignancy or osteomyelitis. In clinical suspicion of stress fracture MRI imaging is very useful for initial diagnosis and follow up, particularly when radiographs are normal. Initial phase sensitivity of radiograph is 15-35%, but increases at follow up to 30-70%. Usually are demostrated radiologically 2-4 weeks after onset of pain. Radiographic findings in osteal bone: Endosteal or periosteal callus formation without fracture line. Circumferential periosteal reaction...

Conclusion

Stress fractures are common complications of repetitive bone loading. Knowledge of imaging finding is of major importance in order to avoid wrong diagnosis.

References

Pepper M, Akuthotav, Mc Carty EC. The pathophysiology of stress fracture.Clin Sports Med.2006 Jan;25(1):1-16. Berger FH, de Jonge MC, Maas M. Stress fractures in the lower extremity. The importance of increasing awareness among radiologists. Eur JRadiol.2007 Apr;62(1):16-26. Anderson MW, Greenspan A. Stress fractures. Radiology 1996 Apr;199(1)1-12. Review. Spitz, Newberg AH. Imaging of stress fractures in the athlete.Radiol Clin North Am. 2002 Mar;40(2):313-31. Campbell SE, Fajardo RS. Imaging of stress injuries of the pelvis. Semin Muskuloskelet Radiol. 2008 Mar;12(1):62-71. S. Eustace. Sports injuries. Examination, imaging and...

Personal Information

Ek. Tavernaraki, Consultant radiologist at<< Evaggelismos>> general hospital Athens, Greece. V. Bizimi,Consultant radiologist at<< Attikon>>unversity hospital Athens, Greece. V. Vantali,Consultant radiologist at<< Evaggelismos>> general hospital Athens, Greece. V. Papalouka,Consultant radiologist at<< Attikon>>university hospital Athens, Greece. D. Chondros,Director radiologist at<< Evaggelismos>> general hospital Athens, Greece. O. Papakonstantinou, Associate professor at<< Attikon>> university hospital Athens, Greece.