Imaging Features and Management of Stress, Atypical, and Pathologic Fractures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Bone Densitometry: 1.50
Procedures: 1.50
DXA Scanning: 1.50

Computed Tomography: 2.50
Procedures: 2.50
Head, Spine, and Musculoskeletal: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Musculoskeletal: 2.50

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Other Imaging Procedures: 2.50

Radiography: 2.50
Procedures: 2.50
Extremity Procedures: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Musculoskeletal and Endocrine Sections: 2.50

Outline

1. Introduction
2. Definitions and Terminology
3. Bone Structure and Pathophysiology
   1. Stress (Fatigue) Fractures
      1. Imaging Findings
      2. Role of Imaging in Managing Stress Fractures
   2. Atypical Femoral Fractures
      1. Imaging Features
      2. Treatment
   3. Pathologic Fractures
      1. Imaging Findings
      2. Additional Treatment Considerations
4. Conclusion

Objectives

Upon completion of this course, students will:

1. define atraumatic/minimally traumatic fractures
2. list the confusing aspects surrounding atraumatic fractures
3. outline what can happen when an atraumatic fracture diagnosis is delayed
4. list the factors that affect optimal management of atraumatic fractures
5. subdivide the term stress fracture into two similar terms
6. state how fatigue fractures commonly occur
7. recall the patient population most affected by fragility fracture
8. define the female athlete triad
9. state where atypical femoral fractures occur in the femoral diaphysis
10. list the basic principles for review when attempting to understand diverse types of atraumatic fractures
11. state the strongest and stiffest material in the body
12. describe the structure of trabecular bone
13. describe the factors affecting the relative proportions of cortical and trabecular bone
14. describe the location of cortical bone
15. describe the location of trabecular bone
16. list the mechanical forces to which bone is exposed
17. recall how long complete bone remodeling can take
18. list the steps in the bone remodeling pathway
19. differentiate between stress, atypical femoral, and pathologic fracture remodeling
20. recall the patient population most commonly affected by stress fracture
21. differentiate between intrinsic and extrinsic factors affecting the etiology of stress fractures
22. list in descending order of frequency the locations where stress fractures most commonly manifest in the lower extremity
23. state the sensitivity for both early and late-stage injuries when utilizing radiography
24. state the modality that is presently not considered to be a first or second-line imaging option for the diagnostic evaluation of suspected stress injury
25. describe the possible manifestations of fractures that arise under tensile stress or in areas of poor vascularity
26. list the treatment requirements for high-risk fractures
27. recall the fatigue fracture line percentage that marks fractures as high-risk
28. state the imaging modality utilized in the classification system proposed by Fredericson et al
29. explain the grading system for medial tibial stress syndrome as seen at MR imaging per the Fredericson et al classification system
30. interpret Table 1 in the article in order to identify atypical femoral fractures
31. recall what type of fractures are more likely to relate to comminution
32. list the radiographic views recommended when an atypical femoral fracture is identified
33. state the percentage of patients that demonstrate a fracture in the contralateral femur either at the time of atypical femoral fracture or in subsequent years
34. list the clinical factors that may increase the risk of atypical femoral fracture
35. recall the patient population most likely to experience pathologic fractures
36. list where pathologic fractures most commonly occur
37. state the best suited imaging modality for discrimination between benign and malignant fractures
38. explain the most important marrow signal intensity related to MRI in the differentiation between benign and pathologic fracture
39. list features that may suggest pathologic vertebral compression fractures
40. recognize features of pathologic fractures demonstrated on multiple imaging modalities