Fracture
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Advanced Imaging of the Diabetic Foot and Its Complications
Copyright 1999 T. Learch, A. Gentili. All rights reserved.
Revised: November 16, 2004.

Fractures

Stress or insufficiency fractures may mimic osteomyelitis on clinically and on imaging studies. Patients present with swollen feet which may be erythematous and hot. However, the lack of soft tissue ulceration should alert the clinician and radiologist to another diagnosis.

Both fracture and osteomyelitis have similar appearances on bone scan. MRI however, is more specific. A fracture line is readily imaged and confirms the diagnosis. In more acute cases, MR imaging may show only bone marrow edema consistent with stress reaction, prior to the onset of fracture. Again, the lack of overlying skin ulceration is inconsistent with osteomyelitis. Common locations (i.e. metatarsal shafts) suggest stress reaction as well.

A B

41-year-old woman with diabetes, clinically suspected by referring surgeon to have osteomyelitis because of hot swollen forefoot.  Sagittal (A) and short axis (B) STIR images demonstrate edematous change about the 2nd metatarsal shaft.  The sagittal image clearly demonstrates fracture line in typical location of insufficiency fracture. There is marked reactive bone marrow edema about the fracture. Note the surrounding soft tissue edema, but lack of skin ulceration. (Click on the images to see larger versions)

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Advanced Imaging of the Diabetic Foot and Its Complications
Copyright 1999 T. Learch, A. Gentili. All rights reserved.
Revised: April 29, 2006.
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