A bone scan will be positive however within 24 hours of the onset of a stress fracture and will very clearly localise the specific bone involved. If they do, they won't appear on x-ray for at least three to four weeks after their onset. Depending on the bone involved, they may fail to show up at all on plain x-rays. "Stress" fractures which occur from repetitive overuse (bone stress) over a period of time (rather than a one-off acute injury) are a commonly occurring sports injury. Any bony or cartilaginous debris or chronically inflamed joint lining (chronic synovitis), can be removed or treated through the arthroscope. The arthroscope is a small telescope inserted into the joint space allowing assessment of the joint surfaces. These may require removal via an arthroscope. This may allow us to see bony fractures which have become unstable and formed loose bodies in the past. Sometimes specific types of imaging (CAT or MRI scans) of the particular area are performed to assess the extent of the damage to the bony and cartilaginous surfaces. This allows the diagnosis of a bony injury to be made and to localise the particular bone involved. Areas of increased bone activity that occur in healing fractures, bone infections and other bone problems will show up as "hot spots" on the bone scan. This requires an injection of a radio isotope dye into the arm which is then taken around the body by the blood stream. What other investigations can be done?Ī bone scan is often used these days to make the diagnosis of bony injury where x-rays are normal but the history and examination findings suggest otherwise. In fact, any athlete who is still limping from an "ankle sprain" a week after their initial injury, with profuse swelling of the ankle and foot, and pain over the front or the back of the ankle rather than just the outer aspect, should assume they have a fracture till proven otherwise. The patient has usually been told that they have simply "sprained their ligaments".Īthletes do need to be aware that x-rays, particularly at the time of the injury and particularly in joints such as the ankle, frequently miss fractures.
Months after their episode of trauma they still have pain and swelling and have been unable to get back to their sporting activity. All too often in sports medicine, one sees patients who give a history very suggestive of a bony injury whom have been x-rayed and discharged with a diagnosis of NBI (No Bony Injury).
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