Patients with stress fractures may present for diagnosis and treatment before the radiographs are abnormal, because radiographs change frequently and lag behind clinical symptoms by weeks.
Dear Schneider
Thanks for your information.
The uptake given by scintigraphy is sufficient for the diagnose or would need another imaging study ? Resonance ?
bone scintigraphy with 99mTc phosphates is the gold standard method for diagnosis of occult or stress fractures, followed by a CT scan with bone window to study presence of bony lesions
Another good tool is scintigraphy and SPECT - CT so you can combine both information. Best regards
Another good tool is scintigraphy and SPECT - CT so you can combine both information. Best regards
dear nelson,
bone scintigraphy with 99mTc phosphates is by far the best method
bets regards
Dear Nelson,
In our experience, sonography is an excellent tool to detect occult fractures. Stress fractures in the tibia, calcaneus, or metatarsal bones can be easily documented very early by sonography with cortical discontinuity, periosteal reaction, and tender point precisely on the bone crack. Patients may even show bridging callus on the sonographs before radiographical signs.
Article Sonographic detection of occult fractures in the foot and ankle
Dear Pei
I really appreciate your comments and the sonography is less expensive.Thank you for sending the article. Regards
In a setting where the advanced imaging modalities are not available, it is the typical clinical history of unaccustomed exercise resulting in pain which is relieved with rest. In superficial bones, the local rise of temperature and bony tenderness are important signs. Typically if you ask the patient to stop the unaccustomed activity for 3 weeks and get the plain X ray at 3 weeks, the callus will be visible at the site of stress fracture.
Dear Ravi
I agree. In much cases the diagnose in the initial phase of stress fracture is clinical i.e. based on signs and symptoms .
Thank you very much
Regards
The modern radiographic devices allow the oportunity to magnify the image so you may asses the bone structure and eventually find imminent stress lesions to the bone architectonics. Of course, in the first line it is the clinical picture and one should think about the presence of stress fracture.
My understanding is that you mean how we make the diagnosis BEFORE doing any investigations. If this is true, then one makes the diagnosis based on the following variables: 1. a young acive patient ( good bone quality) involvec in vigorous activties. 2. tenderness located in a specific bone of the lower limb.
The undelying concept in stress fractures is this: abnormal force on normal bone
Dear Dr. Motsitsi, you are right to some extent. Unfortunately, I have to disagree with you as far as the stress fracture in "a young active patient" is concerned. The original stress fracture of metatarsals was described in the past by Deutschlaender in young newly recruited soldiers (not trained ) who hade been subjected to extreme loads (long walking, hard marching, extreme exercises, etc). This did not happen to experienced and well adapted to repetitive loading "old soldiers". So the bone is normal, but not adapted to loads.
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