Which imaging modality is commonly used first to evaluate a suspected tibial stress fracture?

Which imaging modality is commonly used first to evaluate a suspected tibial stress fracture?

• A. MRI
• B. CT
• C. Bone scan
• D. X-ray

Answer: (D)

When evaluating a suspected tibial stress fracture, the first imaging step is plain X-ray because it is widely available, inexpensive, and can reveal established injuries such as cortical lines, periosteal reaction, or localized sclerosis. Early on, however, X-rays can be normal even with a fracture, so a negative result doesn’t rule out the injury. If suspicion remains after a normal film, MRI is then used for its high sensitivity to bone marrow edema and stress reactions, while CT can help define fracture geometry and fracture healing, and bone scanning is a more historical option with lower specificity.

When evaluating a suspected tibial stress fracture, the first imaging step is plain X-ray because it is widely available, inexpensive, and can reveal established injuries such as cortical lines, periosteal reaction, or localized sclerosis. Early on, however, X-rays can be normal even with a fracture, so a negative result doesn’t rule out the injury. If suspicion remains after a normal film, MRI is then used for its high sensitivity to bone marrow edema and stress reactions, while CT can help define fracture geometry and fracture healing, and bone scanning is a more historical option with lower specificity.