Using ultrasound to image lower limb stress fractures

Today a very interesting précis of a relatively new diagnostic investigation for stress fracture, Ultrasound. Cheap, easy, non-ionising, and specific. Well worth considering.

We all know that stress fractures are best imaged by isotopic bone scan, CT scan, or even better MRI right? Wrong! The old is new technique of diagnostic ultrasound is rapidly gaining traction as a reliable early diagnostic technique for stress fracture.

Radiographer Christine Fenech, tells us more...

A 23 year old female patient presented at my placement site with a request for a left foot x-ray, with the clinical details as follows – query stress fracture, pain over mid foot, previous xray two weeks ago showed no bony injury.

Stress fractures (SF) can be divided into two mechanisms.

Fatigue SF are the result of repetitive abnormal stress on normal bone (Khy, Wyssa, Bianchi, 2012). They are common among the military and athletic populations (Moran, Evans Hadad, 2008). SF most commonly occur in the femur, tibia, and metatarsals (Moran, Evans, Hadad, 2008), and account for around 8% of track and field athlete injuries (Palpalada et al. 2012). Recreational sports injuries have also significantly increased over the past decade, especially among individuals whose fitness level is ill suited to the nature or intensity of their chosen activity (Khy, Wyssa, Bianchi, 2012).

Insufficiency SF's occur from stress applied to bone weakened by a variety of systemic disorders such as osteoporosis (Khy, Wyssa, Bianchi, 2012). The patient had no known bone conditions and had recently increased her training intensity, therefore it is presumed if she does have a stress fracture it would be a fatigue fracture. 

4th stressy.jpg

Early diagnosis of SF is important as they can often be underestimated, and continued activity will increase the severity of the fracture (Palpalada, 2012). This is especially significant among the military and athletic subgroups as they may be hesitant to reduce their training pre-diagnosis (Palpalada, 2012). There is a reliance on imaging to confirm diagnosis as the symptoms of a SF can often mimic other pathologies such as muscular strain, periostitis, infection, bursitis, neoplasm, chronic exertional compartment syndrome, or nerve entrapment (Palpalada et al. 2012).

Simon Bartold
Director of Bartold Clinical