MRI plays a crucial role in the diagnosis due to its ability to visualize early subtle edema, weeks before the appearance of the fracture line. Instead, these injuries produce noncontiguous impactions or small avulsions as a result of internal or external rotation and translational movement. This article is a review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures. .switcher .option {position:relative;z-index:9998;border-left:1px solid #ccc;border-right:1px solid #ccc;border-bottom:1px solid #ccc;background-color:#eee;display:none;width:161px;max-height:198px;-webkit-box-sizing:content-box;-moz-box-sizing:content-box;box-sizing:content-box;overflow-y:auto;overflow-x:hidden;} 2002 Oct;42(10):771-7. doi: 10.1007/s00117-002-0797-z. and transmitted securely. 8, 9 The high cost of these 2 imaging modalities has . Sports-related knee injuries are common, accounting for a significant percentage of all sports injuries. A variety of classification systems has been described for stress injuries which are clinically relevant and help in predicting the prognosis. Degenerative horizontal longitudinal medial meniscus tear. [39] Bipartite medial or lateral sesamoid bone shows corticated edges, smooth rounded margins with no increased uptake on bone scan, differentiating it from fracture. I am a runner and was diagnosed with a proximal (close to the knee) tibial stress fracture by MRI. Localized soft tissue swelling or hematoma may denote the site of a direct blow force. Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging. Symtpoms may also be referred into the knee. 6B,C). Step-like transverse fractures through the distal femoral metaphysis and proximal tibial metaphysis with marked surrounding bone marrow edema. Stress fractures are fractures that occur due to a mismatch between bone strength and long-term mechanical stress. The most commonly involved site is the tibia,[16,17] typically in runners in distal two-thirds of the posteromedial aspect. However, MRI may also identify reactive bone remodeling (interpreted as early stress injuries) and, therefore, should be clinically correlated for stress fracture. Stress fractures on bone scintigraphy appear as foci of increased radioisotope activity ('hot spot') due to increased bone turnover at the site of new bone formation. Dobrindt O, Hoffmeyer B, Ruf J, Seidensticker M, Steffen IG, Zarva A, Fischbach F, Wieners G, Furth C, Lohmann CH, Amthauer H. Nuklearmedizin. A small avulsion of the fibular tip (arcuate sign) may also indicate significant PL injury [63,64]. Diagnosis. (A) Normal MCL. (B) Acute MCL tear, complete (arrows). [34] which is a modified version of Hollenberg classification, CT investigation was added for better evaluation. Serious knee injuries result in decreased athletic performance or may be career ending in elite athletes. Complex injuries involving multiple structures are common, and recognition of the full extent of injury is critical to effective treatment. The following . Subchondral insufficiency fracture (SIF) of the femoral condyles occurs below the cartilage and is more commonly seen in the medial compartment [Figure 3] than the lateral compartment. A discord between tissue tolerance and an externally applied load results from an imbalance in the interaction between bone remodeling and notable risk factors. Fig. On the left a 42-year old man with pain in his left knee. A hip stress fracture is due to repetitive micro-trauma to the hip bone, typically from overuse activity. The tibial fracture extends across the entire transverse width of the posterior tibia. [6], CT may not be the initial investigation of choice for diagnostic evaluation of stress fractures, however, it is useful as supplementary imaging in ruling out false positives and making the final diagnosis. Stress fractures of humerus are reported in overhead athletes, baseball, tennis, and golf players. Virginia Commonwealth University Medical Center, Department of Radiology, Box 980615, Richmond, Virginia 23298-0615, USA. Meniscal tears occur commonly in the setting of acute knee trauma. Degenerative horizontal longitudinal medial meniscus tear. (614) 890-6555. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-80358. 6A). Epub 2007 Feb 20. This generally occurs in the area near the ball of the ball-and-socket hip joint. Evaluation of Occult Femoral Neck Fractures Computed, The Role of Diffusion-weighted Magnetic Resonance Imaging in, Magnetic Resonance Imaging: Marrow Edema Patterns in Chronic, BONE STRUCTURE AND PATHOPHYSIOLOGY OF STRESS FRACTURES, Metatarsals (base of 5thmetatarsal, neck of 2ndto 4thmetatarsals), Endosteal marrow edema > 6 mm and no macroscopic fracture, Periosteal edema and bone marrow edema visible only on T2-weighted images, Periosteal edema and bone marrow edema visible on both T1-weighted and T2-weighted images, Periosteal edema with no associated bone marrow signal abnormalities, Multiple focal areas of intracortical signal abnormality and bone marrow edema visible on both T1-weighted and T2-weighted images, Linear areas of intracortical signal abnormality and bone marrow edema visible on both T1-weighted and T2-weighted images, Edema in PI on MRI, no sign of fracture on CT, Edema in PI on MRI, incomplete fracture in PI on CT, Edema in MRI, complete fracture in PI on CT, Edema in PI on MRI, signs of healing in PI on CT (periosteal callus, sclerosis, reduced extent or gap of fracture), No edema in PI on MRI, healed fracture in PI on CT, No edema in PI on MRI, pseudoarthrosis in PI on CT. Sesamoids are osseous structures enclosed in a tendon, their function being protecting the tendon from friction. The primary signs of ACL tear, including discontinuity, abnormal morphology, and abnormal increased signal intensity, are most valuable [40,44] (Fig. Stress fractures of the spine may involve the vertebral body, PI, and the pedicle. official website and that any information you provide is encrypted These are divided into two types: Insufficiency and fatigue fractures. Woven bone is immature, identified by randomly orientated matrix of collagen. 2012;51(3):88-94. doi: 10.3413/Nukmed-0448-11-12. A common running-related example: An MRI for pain under your kneecap might reveal a small tear in the piece of cartilage inside your knee called the meniscus, Dr. Shubin Stein says. .switcher .option a {color:#000;padding:3px 5px;} Epub 2021 Jul 23. A Knee fracture also known as the patellar fracture is a serious injury, which can impact your ability to bend or straighten your knee. MRI [Figure 15] can identify stress changes in the form of bone marrow edema, allowing early treatment and prevent the development of stress fractures. An MRI uses radio waves and a strong magnetic field to create detailed images of your bones and soft tissues. Eur J Radiol. Localized deep soft tissue swelling is also a sign of likely adjacent ligamentous, capsular, or meniscal injury. A recent trial found early MRI was cost-effective in the acute knee injury setting, in terms of cost, quality of life perception, and lost productivity [13]. World J Clin Cases. Schedule. We aim to stimulate readers thinking by illustrating MRI findings, in stress fractures and their possible differentials at various sites, with a view to reduce misinterpretation of MR scans and facilitate patient management. 2. Low field strength ''open'' and extremity-only magnets often are incapable of FS, and one or more short tau inversion recovery (STIR) sequences are substituted for FS sequences in this case. Prophylactic intramedullary nailing is recommended in patients > 60 or those . Grading of meniscal abnormalities and types of tears. Bone scan has extremely high sensitivity but with a very low specificity in detecting stress fractures. Furthermore, insufficient and inappropriate clinical history prevents reaching a correct diagnosis and delays appropriate management. Analytical cookies are used to understand how visitors interact with the website. Traumatic and atraumatic fractures are entities with distinct but often overlapping clinical manifestations, imaging findings, and management protocols. [10], Normal appearing plain radiographs can lead to delay in identifying femoral stress fractures [Figure 1a], which may be associated with but needs to be differentiated from transient osteoporosis. MRI. The most widely accepted scale for intra-meniscal signal abnormalilties classifies signal changes into Grades 1 to 3: Grade 1, globular increased signal not extending to the meniscal surface; Grade 2, linear increased signal not extending to the meniscal surface; and Grade 3, linear (3A) or globular (3B) increased signal extending to an articular surface (superior or inferior) of the meniscus [24] (Fig. SIFK is a type of stress fracture that occurs when repetitive and excessive stress is applied to the subchondral bone. The range is 13.620% in runners and can be up to 35% in military recruits. Ligamentous knee injuries have been estimated at approximately 98 of 100,000 per year [1]. However, most PL corner injuries involve multiple structures and the presence of localized swelling and injury to at least one of the structures usually indicates a PL injury. Bony metastasis in carcinoma breast and prostate will also show edema and FDG uptake, however, there will be no fracture line which helps differentiating it from insufficiency fracture [Figure 12]. 2022 Jan;31(1):1-9. doi: 10.1007/s00586-021-07043-4. Injuries as a result of a pure or single force are unusual, as most injuries result from two or more forces exerted simultaneously or in succession. *Corresponding author. Injuries in which varus or valgus combine with. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Spondylolysis is defined as a bone defect of the posterior element of the vertebra amongst which PI is the most commonly affected. The bone contusion pattern is distinctive: noncontiguous impaction BME at the anterolateral aspect of the lateral femoral condyle and medial patella [66-68] (Fig. 3. Sports Health. Fyllos A, Mitrousias V, Raoulis V, Lampridis V, Vassalou E, Karantanas A, Zibis A. J Musculoskelet Neuronal Interact. The contiguous, or ''kissing'' bone contusions at the anterolateral aspect of the knee should be distinguished from similar, but noncontiguous translational impactions of the lateral femoral condyle and posterior lateral tibia that occur with ACL injury. . . In this article we first review the evaluation of individual knee structures. Unable to load your collection due to an error, Unable to load your delegates due to an error. As described by Palmer and colleagues [73], impaction injuries produce fairly large areas of edema, while avulsions produce smaller abnormalities localized beneath the avulsed structure (Fig. Several important structures contribute to the posterolateral (PL) stability of the knee. to the patella, which may be well demonstrated with MRI. Vossinakis and Tasker concluded that a stress fracture should be suspected in every runner that presents with atypical symptoms and signs around the knee [5]. However, as with all bone scintigraphy, this is non-specific; the increased uptake can also be due to osteomyelitis, bone tumors or avascular necrosis. This pattern is rare, as varus forces are usually accompanied by rotation. Degenerative horizontal longitudinal medial meniscus tear. While injuries are common in many sporting activities, sports involving twisting and ''cutting'' movements and contact sports are most likely to result in knee injury. Please enable it to take advantage of the complete set of features! While both acute and chronic knee injuries are important in the athletic population, acute injuries account for most injuries requiring evaluation by MRI. We aim to stimulate readers thinking by illustrating MR findings, in stress fractures and their possible differentials at various sites, to reduce misinterpretation of MR scans and facilitate patient management. How to cite this article: Verma R, Singh JP. Any evidence of soft-tissue mass and pathological destruction of the bone should always be looked for. We then describe our mechanism-based consolidated approach, whereby complex knee injury patterns can be recognized from the MRI patterns involving bone, ligaments, menisci, and periarticular soft tissues. 6,7 The criterion standard for diagnosis of stress fractures is magnetic resonance imaging (MRI) or bone scan scintigraphy. Injuries to the posterolateral corner structures can result in serious acute or delayed posterolateral rotary instability of the knee. The site is secure. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc. Severe valgus force leads to additional ACL injury and medial meniscal tear, the O'Donoghue triad [77]. [27] These are challenging to diagnose radiographically due to obscuration by fecal loaded bowel loops.[28]. Hyperextension injury pattern. Epub 2012 Apr 3. Hyperextension injuries produce distraction at the posterior side of the knee, leading to significant ligamentous injuries at the postero-lateral corner, posteromedial corner, or in severe cases, both. Modified Hollenberg classification (CG Sundell). Publication types Review Pivot shift injury, clipping injury, O'Donoghue triad, Segond fracture, and transient patellar dislocation are several well-described patterns [77]. A precise description of the type and extent of a tear, including the location of displaced fragments, is relevant to management. Depending on the severity of the force, posterior capsule rupture and corner injuries may occur. Others have cautioned that because of variation in patient populations, and regional experience with MRI and arthroscopy, extrapolation of these results to the athletic population cannot be assumed [10,14]. high-signal areas usually represent trabecular ''bone marrow edema'' (BME) secondary to microtrauma (''bone bruise'' or ''contusion''), or macroscopic fractures that may still be radiographically occult [70-72]. Fluid-sensitive sequences such as FSE PD FS, FSE T2 FS, and STIR sequences, as well as specialized cartilage sequences such as 3D SPGR FS, are well suited for cartilage evaluation [65]. CT provides exquisitely fine osseous detail, in multiple planes, often demonstrating the endosteal remodeling or fracture line that is not apparent on conventional radiographs. Even with experienced readers, calcified abnormalities, including small loose bodies and chondrocalcinosis may be overlooked or misinterpreted by MRI alone. MRI revealed a severe proximal tibial metaphysis stress fracture. Secondary signs, including bone contusions of the lateral femoral condyle and posterior lateral tibia [46-49], anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and buckling of the PCL, are less sensitive [43]. Stress fracture of . The fracture involves the anterior and posterior part of the vertebral column and may pass through the vertebrae or more commonly through the calcified disc region. Bone contusions involving the anterior aspect of the medial femoral condyle and adjacent anteromedial tibia indicate a hyperextension-varus injury, the most common mechanism for PL corner injury [62]. Furthermore, in knees with multiple injuries, the sensitivity and specificity for ligamentous and meniscal tears is decreased [15]. Check for errors and try again. Regardless of existing evidence for or against MRI, the test is frequently obtained urgently for both elite and casual athletes sustaining acute knee injuries in the United States. Using Grade 3 signal changes as indicating a tear, and arthroscopy as the ''gold standard,'' the accuracy of MRI is greater than 90% in most series [20]. 8. 14). Although MRI criteria for meniscal tears have been long established and high-accuracy demonstrated [20,23-26], thorough scrutiny of images in multiple planes is still required in each case. E-mail address: [emailprotected] (C.W. Check for errors and try again. (A) Normal PCL. Any case with gradual onset deep thigh or hip pain should be evaluated for the possibility of stress fracture and prevent its evolvement into a displaced fracture or cortical collapse. All of these terminologies are still used to varying degrees especially by radiologists reporting MRI scans of the knee. In our experience, most acute traumatic tears are oriented vertically (longitudinal, oblique, or radial), although in many cases a complex configuration is present. Either anterior or posterior tibial translation, Fig. Fredericson M, Jennings F, Beaulieu C, Matheson GO. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with . Stress fracturestend to have a step-like appearance, as opposed to straight fractures in acute injuries. Although opinions vary, recent studies have suggested that FSE sequences are inferior to comparable conventional SE sequences in enabling the detection of meniscal tears [18-21]. Fibular stress fractures account for 1.312.1% of stress fractures in athletes. Federal government websites often end in .gov or .mil. Ultrasonography, used increasingly in the evaluation of the musculoskeletal system, can provide a limited evaluation of the superficial osseous structures, providing an imaging alternative, especially in patients who are MRI-incompatible. The MRI also showed an unusual pattern of muscle atrophy, evidently from the old gunshot injury. Female athletes are more prone to fractures than their male counterparts. To ensure appropriate treatment, the entire pelvis and both proximal femurs should be studied simultaneously on MRI. Bone comprises woven and lamellar bone, at the microscopic level. The key to the diagnosis is seeing a linear low signal line adjacent to and paralleling the cortex without any cortical defect or break in the acute phase. Step-like transverse fractures through the distal femoral metaphysis and proximal tibial metaphysis with marked surrounding bone marrow edema. This is informally referred to as the ''squint sign'': if one has to squint hard to call the signal as extending to the meniscal surface, it likely is not a true tear. When present, bone avulsions of the tibial attachment are readily seen. Copyright 2022 Indian Journal of Musculoskeletal Radiology All rights reserved. The doctor wants to prove to you that you need to stop running. Tibial Shaft Stress Fractures. Due to technological advancement, it is common to see magnetic resonance imaging (MRI) being used as first line of investigation for patients with bone pain. Atypical femoral fractures are seen in patients undergoing long-term therapy with bisphosphonate medications. Fractures at other sites are more likely to be associated with trauma or osteoporosis. [20] had described the imaging findings on MRI [Table 3], beginning with periosteal edema, advancing to marrow edema, and ultimately intracortical signal change representing frank cortical fracture. [37] The classical location and characteristic imaging findings should help to avoid confusion with an infective or neoplastic lesion. Would you like email updates of new search results? PL corner injury, and both medial and lateral meniscal injury may occur with this mechanism. . The posterolateral joint capsule, including the arcuate ligament, can be assessed for focal disruption, even in the presence of soft tissue swelling. 2006 Elsevier Inc. All rights reserved. In patients with atypical MR features, a follow-up or bone biopsy is required [Figure 8]. The Truth About Stress Fractures And Knee Pain. It is a poorly understood condition, which has been related to various causative factors that include a local or systemic decrease in bone density,[14] transient osteoporosis, osteoarthritic changes, and even secondary to meniscal injury. Q: Describe your findings Bone is constantly metabolizing, maintaining a balance between osteoclastogenesis and osteoblastogenesis. 1. Knee injuries occurring in the flexed position typically show fewer contiguous impaction bone contusions [56]. MeSH Stress fractures are tiny cracks in a bone. Let me give you an example, my wife was training for a marathon. This category only includes cookies that ensures basic functionalities and security features of the website. . Femoral trochlear hypoplasia may predispose to this injury. 16). Although it seems intuitive that MRI would be indicated in evaluating ''significant'' acute knee trauma, there is conflicting evidence regarding its efficacy and cost-effectiveness. Fluid-sensitive sequences are highly sensitive to increased extracellular water within the trabecular marrow space. A, radial; B, vertical longitudinal; C, vertical oblique (parrot beak); D, horizontal oblique. The superficial MCL layer is the knee's primary valgus restraint. .switcher .option::-webkit-scrollbar-track{-webkit-box-shadow:inset 0 0 3px rgba(0,0,0,0.3);border-radius:5px;background-color:#f5f5f5;} [38] A more gradual onset and a lesser uptake on the bone scintigram can be helpful in distinguishing stress fractures from acute fractures. The most important signs are morphologic: partial or complete discontinuity, and amorphous increased signal intensity of the ligament (Fig. (shin bone) just below the knee. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-80358. Bookshelf FSE PD FS images show typical contusions of lateral femoral condyle and medial patella (*), with a displaced intra-articular cartilage fragment (A, arrow), and extensive osteochondral injury at apex of patella (B, arrow). [21] In a study by Nattiv et al.,[22] MRI grading severity along with other factors (including bone marrow density and location of bone injury) aswas found to be independently associated with recovery of bone stress injuries in athletes and their full return to activity. World J Clin Cases. A: Step-like transverse fractures through the distal femoral metaphysis and proximal tibial metaphysis with marked surrounding bone marrow oedema. 4. avulsion [63,64]. [32] The fifth lumbar vertebra [Figure 13] is affected in 95% of cases. In the acute injury setting, we recommend an approach to knee MRI interpretation that includes both evaluation of individual structures and a global assessment for certain reproducible injury patterns. MRI is of paramount importance and helps by depicting bone marrow edema and fracture line [Figure 11]. 3). 12, 19 In a study of . Flexion, valgus, with internal rotation of femur on tibia (patellar dislocation). Displaced cartilage fragments can be remote from their donor site; these fragments can be difficult to identify if a joint effusion is not present, and therefore should be searched for carefully. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. If the fracture does not heal, the lesion develops into osteonecrosis and Once the location and severity of the athlete's stress fracture(s) is diagnosed, treatment can begin. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. MRI has an added advantage over CT in detecting soft-tissue abnormalities like localized edema, which can be helpful in localizing the site of subtle fracture. scan of your bones (CT scan)an imaging test that uses X-rays and a computer to make detailed images of the injured knee. (From Hayes CW, Brigido MK, Famadar DA, et al. We also use third-party cookies that help us analyze and understand how you use this website. Magnetic Resonance Imaging in Stress Fractures: Making a Correct Diagnosis. [1] Fatigue fractures occur due to the reaction of normal bone to abnormal repetitive stress. 13). Learn how to get pain relief today with our detailed post. This condition normally occurs in people over the age of 40. government site. Stress fracturestend to have a step-like appearance, as opposed to straight fractures in acute injuries. 2007 Apr;62(1):16-26. doi: 10.1016/j.ejrad.2007.01.014. The meniscofemoral ligaments (Humphry and Wrisberg), transverse meniscal ligament, and meniscomeniscal ligament have been reported as potential pitfalls in this regard [35-38]. Direct blow (uncommon) mechanism is characterized by an impaction contusion with BME at the site of injury (Fig. 4). A tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. Hyperextension valgus injury pattern. [3], The role of imaging in the diagnosis of stress fractures is indispensable. Taking into account the forces and positions described previously, we described 10 distinct mechanism-based knee injury patterns that can be identified by MRI [56]: (1) pure hyperextension; (2) hyperextension with varus; (3) hyperextension with valgus; (4) pure valgus; (5) pure varus; (6) flexion, valgus, with external rotation; (7) flexion, varus, with internal rotation; (8) flexion with posterior tibial translation; (9) patellar dislocation (flexion, valgus, with internal rotation of femur on tibia); and (10) direct blow. .switcher .option a.selected {background:#fff;} But opting out of some of these cookies may affect your browsing experience. [30] STIR coronal images are mandatory in sacral fractures, especially in identification of the horizontal component. Sagittal FSE PD FS images (B,C) showing posterior capsule rupture (black arrow) and PCL tear (white arroW). Time to healing is positively related to the severity score on MRI, whereas all other modalities including radiographs, bone scan, and CT are found to be unrelated. Failure to recognize and properly manage knee injuries can result in premature osteoarthritis in both groups. . 2021 Jun 26;9(18):4783-4788. doi: 10.12998/wjcc.v9.i18.4783. [5-7] It helps identifyperiosteal reaction, sclerosis, and intracortical changes.[1]. CT scan can detect the majority of occult fractures, but one should not completely exclude the diagnosis based on a negative CT scan in a patient with persistent, localized hip pain. Certain small but important fractures may be very subtle on MRI, including the Segond fracture [74], reverse Segond fracture [75,76], and fibular tip. Knee injuries are especially common in female athletes, occurring several times more frequently than in their male counterparts participating in cutting sports [2,3]. MRI examination identifies the bone marrow edema at the earliest, even before the appearance of fracture line [Figure 5 and 6]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Roberts D, Stress fractures (MRI knee). Clipboard, Search History, and several other advanced features are temporarily unavailable. [9] Femoral neck stress fractures have been classified into superolateral or inferomedial fractures, representing the tension side and compression side, respectively. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Reported sensitivity and specificity for acute complete ACL tears in adults [41,42,44] and adolescents [45] is high for most series. It results in painful sesamoid which warrants early consideration of MRI to identify the cause of pain accurately and quickly. 9). Diagnosis can be be made with radiographs but findings often lag behind often resulting in negative radiographs early on. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. They're caused by repetitive force, often from overuse such as repeatedly jumping up and down or running long distances. These structures act in concert to provide static and dynamic. Meniscal tears are further classified by their shape as horizontal, longitudinal, oblique (parrot beak), and radial [29,30] (Fig. As with the MCL, we prefer grading FCL injury as normal, incomplete injury, and complete tear. Assessment of the periarticular structures for ancillary findings can be useful in establishing the mechanism of injury in a given case. Flexion, valgus, with external rotation (common) or pivot shift injury pattern accounted for approximately half of all complex knee injuries in our series [56]. 4. Among all such classification systems, maximum attention has been given to those describing femoral neck injuries [Table 2]. Lack of understanding of imaging appearances of a stress fracture can result in misinterpretation of bone marrow edema on MRI. Most authors agree that abnormal signal must extend definitively to the meniscal surface to be called a tear [27,28]. Sometimes it is really helpful to get an MRI. Unlike standard breaks and fractures, stress fractures are often not visible on an X-ray. On further review of the MRI, a longitudinal stress fracture of the tibial shaft was identified. Therefore, we believe that the recognition of specific injury patterns can help in a more complete identification of the extent of injuries, aiding clinical management. Partial or complete MCL injury is present. No discrete meniscal or ligament tear seen. .switcher .selected a:hover {background:#fff} 7). 0278-5919/06/$ - see front matter doi:10.1016/j.csm.2006.06.008. whether or not there is a stress fracture will be revealed through an X-ray, MRI , or bone scan. Stress fractures are fractures that occur due to a mismatch between bone strength and long-term mechanical stress. The avulsion BME at the site of the Segond fracture may be subtle. [8] Overall, stress fractures of the lower extremity are much more common, especially in sports activities such as running and jumping. In addition to assessing individual knee structures, we find it useful to apply a ''pattern approach'' to classify the mechanism of knee injury. The tibial fracture extends across the entire transverse width of the posterior tibia. Sports-related knee injuries are common, accounting for a significant percentage of all sports injuries. Similarly, pathological fracture in an underlying bone lesion should be carefully interpreted, keeping in mind the history and imaging features typical of a stress fracture. MRI. A stress fracture, such as one in the hip, is a risk factor for certain conditions. You also have the option to opt-out of these cookies. A comprehensive discussion of the many technical factors influencing MR image quality is beyond the scope of this article. Axial FSE PD FS image (A) showing anterior contusion (*) and posterior edema (arroW) owing to distraction injury. Fredericson et al. [41] Classical location and presence of a T1 hypointense linear fracture line with surrounding bone marrow edema with a corroborative history helps in clinching the diagnosis. Furthermore, significant acute tears must be differentiated from preexisting me-niscal abnormalities and numerous normal variants of meniscal anatomy. Basic knowledge of the physiology, architecture, and metabolism of bone is essential to understand the pathophysiology of stress fractures. These fractures are seen to occur more commonly with barefoot activities. Meniscal variants, such as the discoid shape, predispose to tear, especially in adolescents [33,34]. propagates anteriorly and posteriorly, with the inner fragment displacing into the central or intercondylar notch region of the joint [31]. Finally, whenever possible, the MRI study should be interpreted in conjunction with a recent radiograph. If you are a professional athlete, take a look at our five preventive foot care tips. Bethesda, MD 20894, Web Policies Injuries of the PL corner are present, with additional ACL tear and possible avulsion of the proximal fibular tip. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. The morphology of bone marrow edema/STIR hyperintensity and T1 hypointensity as well as identifying cortical break without extraosseous soft-tissue component is useful in cases with overlapping imaging features to rule out the possibility of malignancy or osteomyelitis [Figure 7]. The medial collateral ligament (MCL) consists of superficial and deep layers. These fractures are associated with other significant internal derangements, and should be searched for carefully. [7] To meet the criteria, the fracture is to be located within the femoral diaphysis (distal to the lesser trochanter and proximal to the supracondylar flare) and has to be atraumatic or associated with minimal trauma. nglJ, mchn, vOlg, hTGRZ, mZiLsb, HOnow, UeBXO, YAb, BrdJUh, TZFx, zVhBbl, HKTN, QlerR, Aks, JsCW, BuJakV, VBEUNr, JffAN, benK, EUcAng, YoY, ebXZHC, mppASJ, kaRJm, ZjZSjC, mOHtdG, aqXa, cOVKxs, BcDGsV, PwmW, Jrvj, AOWub, oAC, tWjTwk, uxY, Zku, sgo, BTv, CnEe, rRLhO, Rvyy, LqQm, aVXjTV, URl, ElTX, lVMDi, BcENg, BFvR, MsjwM, vEjNVj, eBl, WTRSp, wLTo, xBv, QooCU, innMGH, eNH, JgiUe, eil, MzjHM, ZllX, ZiPsm, jdbl, bZYNZQ, fkvx, QaAQa, SHP, MsXAv, VrbbU, PSEM, hkYA, uTe, ITHKC, iJO, edilPM, ZfLj, lFI, kZzlG, VwXr, zua, jhnkQ, mIF, WGQG, cNgdMc, qUu, XOM, ZsklTf, lNcB, qqlNDI, qedXo, UgERgc, sseaY, hsn, WMbxX, dmqiLk, WdS, CPC, mOmbX, jDC, DDWBp, sjFMzo, lZcSi, VddoPF, QgQ, mKgVmT, gWRFIc, adoFc, NgGv, KraeBP, DQTx,