investigation of choice in stress fracture:
Ans. b. MRI (Ref: b Apley's 9/e p724- 725)Investigation of choice in stress fracture is MRI" The earliest changes, particularly in 'spontaneous' undisplaced osteoarticular fractures, are revealed by MRl. This investigation should be requested in older patients (possibly with osteoporosis) complaining of sudden onset of pain over the anteromedial part of the knee. "--Apley's 9/e p725Stress FractureA stress or fatigue fracture is one occurring in the normal bone of a healthy patient, due to small repetitive stresses of two main types: bending and compression.Commonly occurs in athletes or new military recruitsQMarch fracture: Fatigue or stress fracture of metatarsals often encountered in military personnelQ.Sites affected:MC bones affected: Metatarsals >Fibula >TibiaQClinical features:History of unaccustomed and repetitive activity or one of a strenuous physical exercise programme.A common sequence of events is: pain after exercise - pain during exercise -- pain without exercise.Affected site may be swollen or red. It is sometimes warm and usually tender; the callus may be palpable. 'Springing' the bone (attempting to bend it) is often painful.Imaging:X-Ray: Plain X-rays taken a few weeks later may show a small transverse defect in the cortex and/or localized periosteal new-bone formation.MRIThe earliest changes, particularly in 'spontaneous' undisplaced osteoarticular fractures, are revealed by MRIQThis investigation should he requested in older patients (possibly with osteoporosis) complaining of sudden onset of pain over the anteromedial part of the kneeQ.Treatment:Most stress fractures need no treatment other than an elastic bandage and avoidance of the painful activity until the lesion heals.An important exception is stress fracture of the femoral neck. This should be suspected in all elderly people who complain of pain in the hip for which no obvious cause can be found.If the diagnosis is confirmed by bone scan, the femoral neck should be internally fixed with screws as a prophylactic measure.
CT scan
MRI
X-ray
Bone scan
Spinal Injuries