Fibula Stress Fracture

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Fibula Stress Fracture

Authors, Editors, Case Information Author: Drew Duerson, MD Affiliation: Nationwide Children's Hospital Senior Editor: Wesley Troyer, DO Clinical Vignette: A 13-year-old female basketball athlete presented with insidious onset lower leg pain. Exam was notable for focal tenderness to the distal fibula. Radiographs of the tibia and fibula were unremarkable. Type of Probe Used: 6-15 MHz linear array transducer Unlabeled Long Axis View of the Distal Fibula Unlabeled Long Axis View of the Distal Fibula Labeled Long Axis View of the Distal Fibula Labeled Long Axis View of the Distal Fibula with a focal area (arrow) of cortical irregularity and thickening with adjacent hypoechoic periosteal elevation. Pain with sonopalpation at this site. Unlabeled Short Axis View of the Distal Fibula Unlabeled Short Axis View of the Distal Fibula Labeled Short Axis View of the Distal Fibula Labeled Short Axis View of the Distal Fibula with hypoechoic periosteal elevation (arrow). Pain with sonopalpation at this site. Normal appearing fibularis brevis and longus. Labeled Short Axis View of the Distal Fibula with Doppler Labeled Short Axis View of the Distal Fibula with power doppler revealing hyperemia of the periosteum and nearby soft tissues. #6 - Video View Video Short axis Cine of the lower leg from proximal to distal revealing normal fibularis brevis and longus muscle and tendons with hypoechoic periosteal elevation of the fibula at the end of the video Interpretation Image Interpretation: The distal fibula has a focal area of cortical irregularity with hypoechoic periosteal elevation and nearby hyperemia on power doppler consistent with an early bone stress injury. Teaching Pearl: Radiographs are usually the first step in the evaluation of a suspected bone stress injury, but may be normal early. Ultrasound can show focal cortical irregularity, periosteal elevation, adjacent hypoechoic edema, and Doppler hyperemia at the site of maximal tenderness. Ultrasound can be a useful office-based adjunct for early stress injury detection, but MRI remains preferred when grading, return-to-sport planning, or high-risk bone stress injury decisions are needed. Persistent symptoms should not be dismissed after a negative ultrasound if clinical suspicion remains high. References: 1. Syrop I, Fukushima Y, Mullins K, et al. Comparison of ultrasonography to MRI in the diagnosis of lower extremity bone stress injuries: a prospective cohort study. J Ultrasound Med. 2022;41(11):2885-2896. doi:10.1002/jum.15977 2. Hoffman DF, Adams E, Bianchi S. Ultrasonography of fractures in sports medicine. Br J Sports Med. 2015;49(3):152-160. doi:10.1136/bjsports-2014-094217 3. Hoenig T, Tenforde AS, Strahl A, Rolvien T, Hollander K. Does magnetic resonance imaging grading correlate with return to sports after bone stress injuries? A systematic review and meta-analysis. Am J Sports Med. 2022;50(3):834-844. doi:10.1177/0363546521993807
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Distal Fibula

Labeled Long Axis View of the Distal Fibula

Unlabeled Short Axis View of the Distal Fibula

Labeled Short Axis View of the Distal Fibula

Labeled Short Axis View of the Distal Fibula with Doppler

#6 - Video

Interpretation

UPCOMING EVENTS

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