Pediatric Stress Fracture

  • Etiology: repetitive microtrauma to normal bone
  • Radiograph: fracture represented by lucency, may see marked cortical thickening in area of injury
  • MRI: periosteal + marrow edema, may show fracture line
  • DDX: Ewing sarcoma – absence of extra osseous soft tissue mass favors stress fracture over Ewing sarcoma

Radiology Cases of Stress Fracture

Radiograph of stress fracture of the femur
AP and lateral radiographs of the femur show on the AP view a transverse non-displaced healing fracture through the distal femoral diaphysis that on the lateral view has periosteal reaction and marked cortical thickening along the posterior aspect of the femur.
Radiograph of stress fracture
AP radiograph of the foot obtained at presentation (left) shows a mild amount of perisoteal reaction around the diaphysis of the second metatarsal that is much better seen on the repeat radiograph from 1 month later (right).