MRI of tibial stress fractures: relationship between Fredericson classification and time to recovery in pediatric athlet
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ORIGINAL ARTICLE
MRI of tibial stress fractures: relationship between Fredericson classification and time to recovery in pediatric athletes Frederick S. Ditmars 1 & Lynne Ruess 1,2 & Cody M. Young 1,2 & Houchun H. Hu 1 & James P. MacDonald 3,4 & Reno Ravindran 3,4 & Benjamin P. Thompson 1,2 Received: 8 February 2020 / Revised: 18 May 2020 / Accepted: 19 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Tibial stress fractures are not uncommon in pediatric athletes. The severity of injury may be graded using magnetic resonance imaging (MRI). Objective To determine whether Fredericson MRI grading of tibial stress fractures can differentiate times to recovery across different grades in pediatric athletes. Materials and methods A medical record search identified all athletes younger than 19 years old who had tibial stress fractures confirmed by MRI and were treated by sports medicine specialists in our clinic system over a 5-year period. Two pediatric radiologists graded MRI exams using the Fredericson system. Time to recovery (in days) was defined in four ways: pain onset to full participation, pain onset to zero pain, first treatment to full sport participation and first treatment to zero pain. Recovery times were compared to tibial stress fracture Fredericson MRI grade and to the use of a recovery device. Results Thirty-eight pediatric athletes (age range: 7–18 years, mean: 15.4±2.2 years) had 42 tibial stress fractures while participating in 12 different sports. About half (55%) were track and/or cross-country athletes. The mean time from diagnosis to report of no pain for all patients was 55.6±5.0 days. We found no significant difference in time to recovery across stress fracture grade or with the use of a recovery device. Conclusion No differences were noted between Fredericson stress fracture grades and different time periods to recovery or between differences in recovery time and the return to full participation in sports, regardless of the use of assistive devices. Keywords Adolescents . Children . Fracture . Fredericson system . Magnetic resonance imaging . Stress fracture . Tibia
Introduction Stress fractures are fatigue fractures that occur as a result of repetitive overuse of normal bone. While stress fractures generally have similar mechanisms of injury and characteristic
* Benjamin P. Thompson [email protected] 1
Department of Radiology, ED 4, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205-2664, USA
2
Department of Radiology, The Ohio State Wexner Medical Center, Columbus, OH, USA
3
Department of Sports Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
4
Department of Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
symptoms, there is a spectrum of imaging findings, which was first classified with magnetic resonance imaging (MRI) by Fredericson et al. [1] in 1995. This landmark study looked specifically at tibial stress fractures. Tibial stress fractures in p
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