Longitudinal tibial stress fractures: A report of eight cases and review of the literature

Purpose: We present the imaging features of longitudinal stress fractures in eight patients and evaluate the literature to determine which tests are most useful for making this diagnosis. Method: Three musculoskeletal radiologists retrospectively reviewed eight cases of longitudinal tibial stress fractures presenting between 1988 and 1994. Reports on 36 cases, cited in the literature between 1960 and 1996, also were reviewed. Imaging modalities used and characteristic imaging features were noted. Results: Plain radiographs had a characteristic appearance in similar to 28% of patients. Initially, plain films were negative, and in most cases, they eventually showed characteristic radiographic features. However, 25% of cases failed to demonstrate a plain film abnormality, with the diagnosis made by other modalities. CT or MRI is often diagnostic, and longitudinal stress fractures have characteristic imaging features with each modality. While sensitive, bone scan has lower specificity than either CT or MRI. Conclusion: Longitudinal stress fractures have characteristic imaging features, and familiarity with these features is necessary for timely and efficient diagnosis, avoiding morbidity due to delay or use of unnecessary tests.