Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Stress Injuries of Bone
KEY FACTS
Terminology
-
Fatigue fracture: Fracture due to abnormal stresses applied (over time) to normal bone
-
Insufficiency fracture: Fracture due to normal stresses applied to abnormal bone
-
Stress response/reaction: Result of stresses upon bone prior to development of macroscopic fracture
-
Chronic physeal stress injury: Repetitive stress to growth plate interrupts normal endochondral ossification
Imaging
-
Stress injury of formed bone
-
Periosteal new bone ± transversely oriented lucent cortical fracture or band of sclerosis on radiographs
-
Transverse linear focus of ↓ signal (fracture line) + poorly defined marrow edema on MR = stress fracture
-
Limited marrow, periosteal, & soft tissue abnormalities without discrete fracture line = stress response
-
-
Chronic physeal stress injury
-
Asymmetric lengthening (“widening”) of lucent growth plate with metaphyseal irregularity on radiographs
-
Top Differential Diagnoses
-
Stress fracture of bone: Osteomyelitis, osteoid osteoma, bone malignancy, bone infarct
-
Stress injury of physis: Rickets, leukemia
Clinical Issues
-
Fatigue fractures occur in
-
Athletes with overuse or recent change in routine
-
Newly ambulating children
-
Children with malalignment or altered weight-bearing
-
Preadolescent children with no recognized ↑ activity
-
-
Insufficiency fractures occur in children with focal or systemic processes leading to bone weakening
-
Treatment includes cessation of stresses with adequate time for bone repair & recovery of normal ossification
Lateral radiograph of the ankle in an 8 year old with limping shows a band of vertically oriented sclerosis in the talar head
, typical of a stress injury.
, typical of a stress injury.
Lateral radiograph of the foot in a 3 year old shows a band of vertically oriented sclerosis in the posterior aspect of the cuboid
, a common location for a stress injury.
, a common location for a stress injury.
AP radiograph shows circumferential benign periosteal reaction
& a focus of medial cortical sclerosis
in the tibia of a 12 year old, consistent with a stress fracture.
& a focus of medial cortical sclerosis in the tibia of a 12 year old, consistent with a stress fracture.
PA wrist radiograph in a 13-year-old female gymnast with pain shows abnormal lengthening of the cartilaginous distal radial physis with metaphyseal irregularity
& loss of the normal thin dense zone of provisional calcification. Note the normal distal ulnar physis
. This is a classic pattern for a chronic physeal stress injury (“gymnast wrist”).
& loss of the normal thin dense zone of provisional calcification. Note the normal distal ulnar physis . This is a classic pattern for a chronic physeal stress injury (“gymnast wrist”).
TERMINOLOGY
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here
