Radiography Area of Interest Repeat In 10-14 Days Short-term (10-14 days) follow-up radiographs are more sensitive than initial radiographs secondary to overt bone reaction in the location of the stress fracture. Follow-up radiographic sensitivity is reported to be 30% to 70% [43]. Detection of osseous change is more limited in areas covered by prominent overlapping soft tissue [31]. If the osseous reaction involves cortical bone, then endosteal/periosteal callus may be visible with or without a fracture line through the cortex. If the trabecular bone is involved, then stress fractures are often more subtle, progressing from patchy areas of increased density into linear areas of sclerosis, oriented perpendicular to the trabeculae. US Area of Interest There is increasing evidence of the usefulness of US in the early diagnosis of stress fractures of the extremities [44,45]. Although later US findings of stress fractures, including subcutaneous edema, periosteal thickening, cortical bone irregularity, local hyperemia [44-46], and periosteal callus are often nonspecific, these findings provide useful information in the setting of suspected stress fracture. Because US cannot evaluate the subcortical bone, trabecular stress fractures may be missed. Variant 3: Adult. Suspect pelvis or hip or sacrum stress fracture. Pregnant patient. Radiographs negative or indeterminate. Next imaging study. Area of Interest: pelvis, hip, or sacrum. Pelvic and hip insufficiency fractures have varied presentations and often insidious onset. Patients frequently present with intractable lower back or pelvic pain, with loss of mobility, independence, and symptom exacerbation Stress (Fatigue-Insufficiency) Fracture with weight bearing [47]. Insufficiency fractures occur in patients with abnormal bone, be it from osteoporosis, irradiated bone, or resumption of activity.
Stress Fatigue Insufficiency Fracture Including Sacrum Excluding Other Vertebrae PCAs. Radiography Area of Interest Repeat In 10-14 Days Short-term (10-14 days) follow-up radiographs are more sensitive than initial radiographs secondary to overt bone reaction in the location of the stress fracture. Follow-up radiographic sensitivity is reported to be 30% to 70% [43]. Detection of osseous change is more limited in areas covered by prominent overlapping soft tissue [31]. If the osseous reaction involves cortical bone, then endosteal/periosteal callus may be visible with or without a fracture line through the cortex. If the trabecular bone is involved, then stress fractures are often more subtle, progressing from patchy areas of increased density into linear areas of sclerosis, oriented perpendicular to the trabeculae. US Area of Interest There is increasing evidence of the usefulness of US in the early diagnosis of stress fractures of the extremities [44,45]. Although later US findings of stress fractures, including subcutaneous edema, periosteal thickening, cortical bone irregularity, local hyperemia [44-46], and periosteal callus are often nonspecific, these findings provide useful information in the setting of suspected stress fracture. Because US cannot evaluate the subcortical bone, trabecular stress fractures may be missed. Variant 3: Adult. Suspect pelvis or hip or sacrum stress fracture. Pregnant patient. Radiographs negative or indeterminate. Next imaging study. Area of Interest: pelvis, hip, or sacrum. Pelvic and hip insufficiency fractures have varied presentations and often insidious onset. Patients frequently present with intractable lower back or pelvic pain, with loss of mobility, independence, and symptom exacerbation Stress (Fatigue-Insufficiency) Fracture with weight bearing [47]. Insufficiency fractures occur in patients with abnormal bone, be it from osteoporosis, irradiated bone, or resumption of activity.