Clinical Value of Grading the Scintigraphic Appearances of Tibial Stress Fractures in Military Recruits

Dutton, Jane A. E.; Bromhead, S. E.; Speed, C. A.; Menzies, A. R.; Peters, A. M.

doi:10.1097/00003072-200201000-00004

Cited by 22 publications

(18 citation statements)

References 9 publications

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“…This may have been due to the severity of the stress fracture. However, Dutton et al, 12 in a study of tibial stress fractures, did not find a significant correlation between the severity of stress fracture as determined by bone scan and time to return to full activity. A future study utilizing MRI to more specifically delineate the severity of the lesion may confirm or refute Dutton's findings and assist in estimating the time course for recovery in patients with stress fractures.…”

Section: Discussionmentioning

confidence: 92%

“…Furthermore, the location of the tibial stress fracture was not associated with a difference in the time to return to full activity. 12 Additional factors that may have contributed to our patient's prolonged recovery period were ongoing female-athlete-triad factors, ibuprofen use 54 in the early stages of her care, suboptimal adherence to the early restricted weight-bearing stages, or overaggressive return to running.…”

Section: Discussionmentioning

confidence: 97%

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Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

Rosenthal¹,

Moore²,

DeBerardino³

2006

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. Diagnosis: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. Discussion: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

Rosenthal¹,

Moore²,

DeBerardino³

2006

J Orthop Sports Phys Ther

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“…Increased uptake on bone scintigraphy in asymptomatic individuals is frequently reported in the literature (10,20) . That might be explained by the bone remodeling and consequent metabolic increase from the early to late stages of the condition.…”

Section: Discussionmentioning

confidence: 96%

Prognostic value of focal scintigraphic findings in clinically suspected cases of tibial stress fracture

2018

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ObjectiveTo investigate the correlation between tracer uptake on bone scintigraphy and recovery time in patients with tibial stress fracture.Materials and MethodsWe evaluated two groups of athletes: those with clinical suspicion and a radiological diagnosis of tibial stress fracture (TSF group, n = 21); and those with no symptoms or evidence of fracture (control group, n = 10). All subjects underwent bone scintigraphy and magnetic resonance imaging with a maximum interval of 7 days between the assessments.ResultsUsing the region of interest technique, we obtained a quantitative evaluation index, comparing affected and unaffected legs. The mean uptake of 99mTc-MDP was significantly higher in the TSF group than in the control group (2.54 ± 0.77 vs. 1.05 ± 0.11; p < 0.001).ConclusionIn our sample of athletes, determining the bone scintigraphy uptake indices provided an objective method to estimate the appropriate recovery time after a tibial stress fracture.

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“…Bone scintigraphy measures bone response to injury by depicting areas of increased osseous metabolism through the localization of radionuclide tracers, particularly Tc-99m-MDP [28]. The degree of uptake depends on the rate of bone turnover and local blood flow, and abnormal uptake may be seen within 6 to 72 h of injury [29]. Whole body bone scans can be performed with relatively low cost and have the advantage of being able to image the entire skeletal system at once.…”

Section: Imaging Evaluationmentioning

confidence: 99%

“…Whole body bone scans can be performed with relatively low cost and have the advantage of being able to image the entire skeletal system at once. The sensitivity of bone scintigraphy is nearly 100 % [29]. The disadvantage of this technique is that the images may demonstrate for up to 2 years after the fracture site has become asymptomatic [28].…”

Section: Imaging Evaluationmentioning

confidence: 99%

Taking a holistic approach to managing difficult stress fractures

Miller

Best

2016

J Orthop Surg Res

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Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.

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Clinical Value of Grading the Scintigraphic Appearances of Tibial Stress Fractures in Military Recruits

Abstract: Contrary to expectation, recruits with higher-grade stress fractures were not less likely to complete basic military training compared with recruits with lower grade stress fractures.

Cited by 22 publications

References 9 publications

Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

Diagnosis of Medial Knee Pain: Atypical Stress Fracture About the Knee Joint

Prognostic value of focal scintigraphic findings in clinically suspected cases of tibial stress fracture

Taking a holistic approach to managing difficult stress fractures

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