STRESS AND INSUFFICIENCY FRACTURES

Stress fractures of the axial and appendicular skeleton typically pres ent as localized pain that develops without a history of specific acut e injury. The differential diagnosis includes primary or metastatic ne oplasms, infections, musculoskeletal soft tissue injuries, nerve compr ession syndromes and joint diseases. Plain radiographs may demonstrate changes consistent with fracture, including a fracture line or fractu re callus. In many cases, however, initial radiographs are normal or n ondiagnostic. This occurs most frequently in three situations: (1) whe n radiographs are obtained soon after the onset of symptoms, before th e appearance of a fracture line or new bone formation; (2) in patients with osteopenia, in whom detection of a fracture line and new bone fo rmation is dit ficult, and (3) when the fracture involves areas of the skeleton that are difficult to study with plain films (including the spine and pelvis). When the plain films are normal, other tests such a s bone scans, computed tomography or magnetic resonance imaging usuall y demonstrate the fracture.