Clinical Significance of Nonfocal Scintigraphic Findings in Suspected Tibial Stress Fractures

Chisin, Roland; Milgrom, Charles; Giladi, M; Stein, Michael D.; Margulies, Joseph Y.; Kashtan, Hanoch

doi:10.1097/00003086-198707000-00027

Cited by 47 publications

(38 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radionuclide bones scans can detect bone stress injuries as soon as two to eight days after symptoms are first noted 45 . Roub and colleagues 45 and subsequently Chisin 14 and Zwas 54 developed a grading system of progressive stress injury using radioisotope findings, with a cortical fracture displaying more intense uptake. The use of bone scans as an independent diagnostic tool is, however, limited by low specificity and lack of visualization of a potential fracture line 19 .…”

Section: Introductionmentioning

confidence: 99%

Correlation of MRI Grading of Bone Stress Injuries With Clinical Risk Factors and Return to Play

et al. 2013

View full text Add to dashboard Cite

Background Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time. Purpose To examine the relationships between MRI grading of bone stress injury with clinical risk factors and time to return to sport in collegiate track and field athletes. Study Design Prospective cohort over 5 years. Methods Two hundred and eleven male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had a pre-participation history, physical exam, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns and prior injuries, as well as a 3-day diet record. Dual energy X-ray absorptiometry was obtained at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiographs were negative, MRI was obtained. Bone stress injuries were evaluated by two independent radiologists utilizing an MRI grading system. MRI grading and risk factors were evaluated to identify predictors of time to return to sport. Results Thirty-four (12 males, 22 females) of the 211 collegiate athletes sustained 61 bone stress injuries during the 5-year study period. The average prospective assessment for participants was 2.1 years. MRI grade and total body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport in the multiple regression model. Specifically, the higher the MRI grade, the longer the recovery time (p<0.002). Location of bone injury at predominantly trabecular sites of the femoral neck, pubic bone and sacrum (p<0.001), and lower total body BMD (p<0.029) independently predicted prolonged time to return to sport. Conclusions Higher MRI grade, lower BMD, and skeletal sites of predominant trabecular bone structure were independently associated with delayed recovery of bone stress injuries in track and field athletes. Knowledge of these risk factors, as well as nutritional and menstrual factors, can be clinically useful in determining time to return to sport.

show abstract

Section: Introductionmentioning

confidence: 99%

Correlation of MRI Grading of Bone Stress Injuries With Clinical Risk Factors and Return to Play

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Apart from mere diagnosis, image-based grading into high- and low-grade fractures can be used for the estimation of healing time and management of SFX [3,8,9]. …”

Section: Introductionmentioning

confidence: 99%

Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging

Dobrindt

Hoffmeyer

Ruf

et al. 2012

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundThe aim was to compare the return-to-sports-time (RTST) following stress fractures on the basis of site and severity of injury. This retrospective study was set up at a single institution. Diagnosis was confirmed by an interdisciplinary adjudication panel and images were rated in a blinded-read setting.Methods52 athletes (female, n = 30; male, n = 22; mean age, 22.8 years) with stress fracture (SFX) who had undergone at least one examination, either MRI or bone scintigraphy, were included. Magnetic resonance images (MRI) and/or bone scintigraphy (BS) of SFX were classified as either low- or high-grade SFX, according to existing grading systems. For MRI, high-grade SFX was defined as visibility of a fracture line or bone marrow edema in T1-, T2-weighted and short tau inversion recovery (STIR) sequences, with low-grade SFX showing no fracture line and bone marrow edema only in STIR and/or T2-weighted sequences. In BS images, a mild and poorly defined focal tracer uptake represented a low-grade lesion, whereas an intense and sharply marginated uptake marked a high-grade SFX. In addition, all injuries were categorized by location as high- or low-risk stress fractures. RTST was obtained from the clinical records. All patients were treated according to a non-weight-bearing treatment plan and comprehensive follow-up data was complete until full recovery. Two-sided Wilcoxon’s rank sum test was used for group comparisons.ResultsHigh-risk SFX had a mean RTST of 132 days (d) [IQR 64d – 132d] compared to 119d [IQR 50d – 110d] for low-risk sites (p = 0.19). RTST was significantly longer (p = 0.01) in high-grade lesions [mean, 143d; IQR 66d – 134d] than in low-grade [mean, 95d; IQR 42d – 94d]. Analysis of high-risk SFX showed no difference in RTST (p = 0.45) between high- and low-grade [mean, 131d; IQR 72d – 123d vs. mean, 135d; IQR 63d – 132d]. In contrast, the difference was significant for low-risk SFX (p = 0.005) [low-grade; mean, 61d; IQR 35d – 78d vs. high-grade; mean, 153d; IQR 64d – 164d].ConclusionFor SFX at low-risk sites, the significant difference in RTST between low- and high-grade lesions allows more accurate estimation of RTST by this approach. Both location of the injury and severity determined by imaging should therefore be considered for prediction of RTST.

show abstract

“…Radionuclide bone scans can detect bone stress injuries as soon as 2 to 8 days after symptoms are first noted. 47 Roub and colleagues, 47 and subsequently Chisin et al 14 and Zwas et al, 56 developed a grading system of a progressive stress injury using radioisotope findings, with a cortical fracture displaying more intense uptake. The use of bone scans as an independent diagnostic tool is, however, limited by low specificity and the lack of visualization of a potential fracture line.…”

mentioning

confidence: 99%

Image-guided Percutaneous Core Needle Biopsy of Musculoskeletal Tumors in Children

Mitton

Seeger

Eckardt

et al. 2014

Journal of Pediatric Hematology/Oncology

View full text Add to dashboard Cite

show abstract

Clinical Significance of Nonfocal Scintigraphic Findings in Suspected Tibial Stress Fractures

Cited by 47 publications

References 0 publications

Correlation of MRI Grading of Bone Stress Injuries With Clinical Risk Factors and Return to Play

Correlation of MRI Grading of Bone Stress Injuries With Clinical Risk Factors and Return to Play

Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging

Image-guided Percutaneous Core Needle Biopsy of Musculoskeletal Tumors in Children

Contact Info

Product

Resources

About