STRESS FRACTURE OF FIBULA

PDFS-SAG

T1 SAGITTAL

T1 AXIAL

PDFS-AXIAL

A 17 year old football player presented with pain in left distal leg and ankle.
MRI shows an incomplete fracture line involving the distal fibular shaft along the lateral aspect with sparing of medial part and is associated with marrow oedema. There is periosteal marrow oedema around it, more on the anterolateral aspect.

STRESS FRACTURES OF FIBULA:

• They are usually secondary to repetitive overuse or stress as in runners, hikers and players.
• May be seen along with stress fractures of tibia or medial tibial stress syndrome or on their own.
• They account for approximately 10% of stress fractures
• They usually involve the distal one-third of fibula
• Plain radiographs may be normal initially. 
• They are best picked on MRI. 
• Bone scintigraphy is also useful.
• On MRI, typical features are those of periosteal thickening and periostitis along with oedema around the fibular cortex.
• An incomplete fracture line may be seen within the cortex.

 REFERENCES:

• Berger F, Jonge M D, Smithius R et al: Stress fractures. Radiology Assistant:2007( e-reference)
• Stoller D W, Ferkel R D, Li A E et al: The Ankle and Foot. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine:Third Edition.Lippincott Williams & Wilkins:1003, 2007.