International Orthopaedics

, Volume 33, Issue 2, pp 489–492 | Cite as

Stress fractures presenting as tumours: a retrospective analysis of 22 cases

  • Andreas FottnerEmail author
  • Andrea Baur-Melnyk
  • Christof Birkenmaier
  • Volkmar Jansson
  • Hans-Roland Dürr
Original Paper


Frequently, the imaging features of stress fractures may be misinterpreted as tumour-like lesions. The aim of this study was to analyse the quality of different examinations in detecting stress fractures mimicking tumour-like lesions in magnetic resonance imaging (MRI). We evaluated 22 cases which were referred to our department with the suspected diagnosis of bone tumours turning out to be stress fractures. Whenever the MRI did not lead to a diagnosis after a second review, computed tomography (CT) scans and, if still required, additional examinations were performed until the fracture was detected. A stress fracture was diagnosed in 15 cases after the additional CT scan, in five cases with the review of the MRI and in two cases with a combination of several examinations. Especially in stress fractures of the tibia and the femur, CT scanning was essential for making a diagnosis by detecting the fracture line. Bone scans and biopsies, in contrast, were not helpful in making a correct diagnosis.


Magnetic Resonance Imaging Single Photon Emission Compute Tomography Stress Fracture Plain Radiograph Bone Scintigraphy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


de façon fréquente les images de fractures de fatigue peuvent être interprétées comme des images pseudo tumorales. Pour cette étude nous avons analysé ce type de lésions à l’aide de l’IRM. Nous avons suivi 22 cas, de tumeur osseuse faisant penser à des fractures de fatigue. Chaque fois, l’IRM ne nous a pas permis de faire le diagnostic après un second examen. Le scanner a été également nécessaire ainsi que d’autres examens pour affirmer le diagnostic de fractures. une fracture de fatigue a été diagnostiquée dans 15 cas après un scanner additionnel, dans 5 cas après avoir revu l’IRM et dans 2 cas avec une combinaison de plusieurs examens. pour une fracture de fatigue du tibia et du fémur, le scanner est un examen essentiel par contre la biopsie n’apporte pas d’aide au diagnostic.


  1. 1.
    Ahovuo JA, Kiuru MJ, Kinnunen JJ, Haapamaki V, Pihlajamaki HK (2002) MR imaging of fatigue stress injuries to bones: intra- and interobserver agreement. Magn Reson Imaging 20(5):401–406PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson MW, Greenspan A (1996) Stress fractures. Radiology 199(1):1–12PubMedGoogle Scholar
  3. 3.
    Daffner RH, Pavlov H (1992) Stress fractures: current concepts. AJR Am J Roentgenol 159(2):245–252PubMedGoogle Scholar
  4. 4.
    Fayad LM, Kamel IR, Kawamoto S, Bluemke DA, Frassica FJ, Fishman EK (2005) Distinguishing stress fractures from pathologic fractures: a multimodality approach. Skeletal Radiol 34(5):245–259PubMedCrossRefGoogle Scholar
  5. 5.
    Fayad LM, Kawamoto S, Kamel IR, Bluemke DA, Eng J, Frassica FJ, Fishman EK (2005) Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol 185(4):915–924PubMedCrossRefGoogle Scholar
  6. 6.
    Feydy A, Drapé J, Beret E, Sarazin L, Pessis E, Minoui A, Chevrot A (1998) Longitudinal stress fractures of the tibia: comparative study of CT and MR imaging. Eur Radiol 8:598–602PubMedCrossRefGoogle Scholar
  7. 7.
    Fredericson M, Bergman AG, Hoffman KL, Dillingham MS (1995) Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 23(4):472–481PubMedCrossRefGoogle Scholar
  8. 8.
    Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, Magaudda L, Blandino A (2005) CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 235(2):553–561PubMedCrossRefGoogle Scholar
  9. 9.
    Garcés GL, González-Montoro I, Rasines JL, Santonja F (1999) Early diagnosis of stress fracture of the lumbar spine in athletes. Int Orthop 23(4):213–215PubMedCrossRefGoogle Scholar
  10. 10.
    Kanstrup IL (1997) Bone scintigraphy in sports medicine: a review. Scand J Med Sci Sports 7:322–330PubMedCrossRefGoogle Scholar
  11. 11.
    Kiuru MJ, Pihlajamäki HK, Ahovuo JA (2003) Fatigue stress injuries of the pelvic bones and proximal femur: evaluation with MR imaging. Eur Radiol 13(3):605–611PubMedGoogle Scholar
  12. 12.
    Kiuru MJ, Pihlajamäki HK, Ahovuo JA (2004) Bone stress injuries. Acta Radiol 45(3):317–326PubMedCrossRefGoogle Scholar
  13. 13.
    Lassus J, Tulikoura I, Konttinen YT, Salo J, Santavirta S (2002) Bone stress injuries of the lower extremity: a review. Acta Orthop Scand 73(3):359–368PubMedCrossRefGoogle Scholar
  14. 14.
    Markey KL (1987) Stress fractures. Clin Sports Med 6:405–425PubMedGoogle Scholar
  15. 15.
    Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG (1987) Stress fractures in athletes. A study of 320 cases. Am J Sports Med 15:46–58PubMedCrossRefGoogle Scholar
  16. 16.
    Milgrom C, Giladi M, Stein M, Kashtan H, Margulies JY, Chisin R, Steinberg R, Aharonson Z (1985) Stress fractures in military recruits. A prospective study showing an unusually high incidence. J Bone Joint Surg Br 67(5):732–735PubMedGoogle Scholar
  17. 17.
    Mulligan ME (1995) The “gray cortex”: an early sign of stress fracture. Skeletal Radiol 24(3):201–203PubMedCrossRefGoogle Scholar
  18. 18.
    Pauleit D, Sommer T, Textor J, Flacke S, Hasan C, Steuer K, Emous D, Schild H (1999) MRI diagnosis in longitudinal stress fractures: differential diagnosis of Ewing sarcoma. Rofo 170(1):28–34PubMedGoogle Scholar
  19. 19.
    Pentecost RL, Murray RA, Bridley HH (1964) Fatigue, insufficiency, and pathologic fractures. JAMA 28(187):1001–1004Google Scholar
  20. 20.
    Scully TJ, Besterman G (1982) Stress fracture—a preventable training injury. Mil Med 147(4):285–287PubMedGoogle Scholar
  21. 21.
    Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, Gaillard P, Michel JL, Ristori JM (2003) Insufficiency fracture. A survey of 60 cases and review of the literature. Joint Bone Spine 70(3):209–218PubMedCrossRefGoogle Scholar
  22. 22.
    Sterling JC, Edelstein DW, Calvo RD, Webb R 2nd (1992) Stress fractures in the athlete. Diagnosis and management. Sports Med 14(5):336–346PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andreas Fottner
    • 1
    Email author
  • Andrea Baur-Melnyk
    • 2
  • Christof Birkenmaier
    • 1
  • Volkmar Jansson
    • 1
  • Hans-Roland Dürr
    • 1
  1. 1.OrthopedicsKlinikum GroßhadernMunichGermany
  2. 2.RadiologyKlinikum GroßhadernMunichGermany

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