Bone Pathology Database

Teaching Version


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2nd image
Third image
Xray detail
X rays and magnetic resonance show an ostopaenic area below the lesser trochanter.
This is suggestive of a stress fracture. Stress fractures in the peritrochanteric region can lead to complete fracture. To prevent this a sliding screw and plate was used to stabilise this region.

Role of Bone scans in the diagnosis of stress fractures These are the most sensitive indicator of bone stress, but have poor specificity. The triple-phase technetium-99m bone scan can differentiate soft-tissue and bony injury. In the first phase, flow images obtained immediately after the intravenous injection of the tracer demonstrate perfusion in bone and soft tissues and may show increased perfusion in acute inflammation. The second phase (the static "blood pool" phase), taken 1 minute after the injection, reflects the degree of hyperemia and capillary permeability of bone and soft tissue. It may also show acute inflammation. The third phase, the delayed image, is taken 3 to 4 hours after injection when approximately 50% of the tracer has concentrated in the bone matrix. All three phases can be positive in patients who have acute stress fractures. In soft-tissue injuries without bony involvement the first two phases are often positive, but the delayed phase shows no or minimal increased uptake.

Record 22