Laboratory Studies
See the list below:
*Both patients with traumatic and pathologic stress fractures require thorough metabolic bone work-up including vitamin D and calcium levels. [22, 23, 24, 25, 26, 27, 28]
Imaging Studies
See the list below:
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Imaging studies in cases of traumatic femur fractures
Radiograph of the chest
Spine radiograph series
Anteroposterior (AP) radiograph of the pelvis
AP and lateral radiograph of the entire femur, hip, and knee [29]
Computed tomography (CT) of the head, neck, abdomen and pelvis if indicated.
CT scan of the fracture for pre-operative surgical planning if indicated (e.g., comminuted intra-articular fracture)
CT of the pelvis is imperative in cases of high-energy femoral shaft fractures to rule out femoral neck fracture. [30]
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Pathologic fracture imaging studies
AP and lateral radiographs of the full length femur
Radiographs of the contralateral femur if concern for metastatic disease
CT if concern for tumor
MRI if concern for tumor or infection
Chest radiograph for both suspected primary or metastatic femur tumor
CT chest to look for metastases from a primary bone tumor
CT chest, abdomen and pelvis if concern for metastatic bone tumor
Bone scan or positron emission tomography–computed tomography (PET-CT) to assess for other areas of involvement if concern for a tumor
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Imaging studies in cases of femoral stress fractures. [31]
AP and lateral radiographs of the femur: Findings are typically delayed for 2-6 weeks after the onset of symptoms; these films are still useful for making a late confirmation of the diagnosis.
Radionucleotide scanning: This is the criterion standard for the diagnosis of stress fractures; these studies are more sensitive than and may show abnormalities 3 weeks before plain radiographs.
Magnetic resonance imaging (MRI): MRIs reveal bone marrow signal earlier in the stress-reaction process than standard radiographs and radionuclide scanning
Bone mineral density evaluation: Use this test to rule out osteoporosis or osteopenia.
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An example of an isolated, short, oblique midshaft femur fracture. Although not seen in this x-ray film, radiographic visualization of both the proximal and distal joints should be performed for all diaphyseal fractures.
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Radiograph of a high-energy femoral shaft fracture.
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Radiograph of a high-energy femoral shaft fracture.
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Radiograph of an intra-articular distal femur fracture.
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Radiograph of an intra-articular distal femur fracture.
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Full length AP radiograph of an intertrochanteric fracture.
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MRI of a patient with a stress fracture at the base of the femoral neck.
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AP radiograph of a healing femoral shaft fracture after intramedullary nailing.
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Lateral radiograph of a healing femoral shaft fracture after intramedullary nailing.
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An intra-articular distal femur fracture treated with intramedullary nailing as well as independent screw fixation.
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An intra-articular distal femur fracture treated with intramedullary nailing as well as independent screw fixation.
