Presentation
20 year-old woman athlete with 1 week of right ankle pain.
Patient Data
Three views of the right ankle are normal.
2 days after inital radiographs, a lower body bone scan was performed. Images were obtained 3 hours following the administration of 25 mCi of Tc99m-MDP IV.
Abnormal focal, intense radiotracer uptake is present in the right distal fibula.
3 views of the right ankle obtained 2 months after initial presentation show smooth lateral cortical thickening along the distal fibular metadiaphysis consistent with a healing stress fract
Case Discussion
Bone scintigraphy is much more sensitive than radiographs for the diagnoses of stress fractures with greater than 80% of stress fractures being occult on initial x-rays (as in this case).
On bone scintigraphy, focal increased uptake, in the appropriate clinical context, is consistent with a bone stress fracture.
The fibula is a less common site for bone stress injuries. The tibia is most frequently involved, with the tarsals and metatarsals being the next most common sites.
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