Fracture, Stress

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
A fracture of normal bone which has been subjected to a repeated stress which is not sufficient to create a complete fracture. The fracture begins as a small cortical infraction that progresses as stress increases or continues.

Pathology:
Not applicable

Imaging Findings:
The proximal tibia is the most common site followed by the femur, fibula, and ischium. A bone scan is best for early diagnosis, showing positive findings 2-3 weeks before the plain films show changes. The earliest plain film changes are cortical bone resorption or infraction at the fracture site with accompanying periosteal reaction. The lucent fracture line is often difficult to see. A transverse sclerotic line may be seen near the fracture site

DDX:
Sclerosis with periosteal reaction:

• Chronic osteomyelitis - usually no linear sclerosis
• Osteosarcoma - has a metaphyseal location, is nonlinear, is lytic, has an associated soft tissue tumor
• Ewings sarcoma - more lytic
• Osteoid osteoma - is eccentric in location and has a central nidus

References:
See References Chapter.

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