![]() With any of these findings, one should carefully evaluate for a hypointense band in the marrow or focal cortical abnormality, indicating stress fracture and necessitating prolonged non-weight-bearing or rest from sporting activity. Classic MRI features include ill-defined focal or diffuse high T2 bone marrow signal due to microtrabecular fractures and intramedullary edema, with or without corresponding low T1 signal and/or periosteal edema (Fig. Radiographs are not very sensitive in the identification of stress injuries of the femoral neck. This causes temporary weakening of the marrow and cortical bone, leading to microtrabecular fractures (stress reaction) and cortical failure (stress fracture). The repetitive overloading stimulates bone remodeling, beginning with osteoclastic activity that is not matched by reparative osteoblastic activity and periosteal maturation, which lag 10–14 and 20 days, respectively. Stress fractures are classified as fatigue, resulting from normal bone being subjected to abnormal repetitive forces, and insufficiency, due to normal stress placed on abnormal bone. Stress injuries are most commonly seen in endurance athletes, such as runners and military recruits, as well as recreational athletes with sudden increase in activity. However, because stress injuries may progress to complete fracture and result in prolonged recovery or career-ending complications, it is imperative to identify these injuries early. Stress injuries are due to a mismatch between native bone strength and chronic mechanical load applied on bone over time.
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