Imaging Features and Management of Stress, Atypical, and Pathologic Fractures

A review of terminology, etiology, and key imaging features that affect management of atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures.

Course ID: Q00599 Category:
Modalities: , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Bone Densitometry: 1.50
Procedures: 1.50
DXA Scanning: 1.50

Computed Tomography: 2.50
Procedures: 2.50
Head, Spine, and Musculoskeletal: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Musculoskeletal: 2.50

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Other Imaging Procedures: 2.50

Radiography: 2.50
Procedures: 2.50
Extremity Procedures: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Musculoskeletal and Endocrine Sections: 2.50


  1. Introduction
  2. Definitions and Terminology
  3. Bone Structure and Pathophysiology
    1. Stress (Fatigue) Fractures
      1. Imaging Findings
      2. Role of Imaging in Managing Stress Fractures
    2. Atypical Femoral Fractures
      1. Imaging Features
      2. Treatment
    3. Pathologic Fractures
      1. Imaging Findings
      2. Additional Treatment Considerations
  4. Conclusion


Upon completion of this course, students will:

  1. define atraumatic/minimally traumatic fractures
  2. list the confusing aspects surrounding atraumatic fractures
  3. outline what can happen when an atraumatic fracture diagnosis is delayed
  4. list the factors that affect optimal management of atraumatic fractures
  5. subdivide the term stress fracture into two similar terms
  6. state how fatigue fractures commonly occur
  7. recall the patient population most affected by fragility fracture
  8. define the female athlete triad
  9. state where atypical femoral fractures occur in the femoral diaphysis
  10. list the basic principles for review when attempting to understand diverse types of atraumatic fractures
  11. state the strongest and stiffest material in the body
  12. describe the structure of trabecular bone
  13. describe the factors affecting the relative proportions of cortical and trabecular bone
  14. describe the location of cortical bone
  15. describe the location of trabecular bone
  16. list the mechanical forces to which bone is exposed
  17. recall how long complete bone remodeling can take
  18. list the steps in the bone remodeling pathway
  19. differentiate between stress, atypical femoral, and pathologic fracture remodeling
  20. recall the patient population most commonly affected by stress fracture
  21. differentiate between intrinsic and extrinsic factors affecting the etiology of stress fractures
  22. list in descending order of frequency the locations where stress fractures most commonly manifest in the lower extremity
  23. state the sensitivity for both early and late-stage injuries when utilizing radiography
  24. state the modality that is presently not considered to be a first or second-line imaging option for the diagnostic evaluation of suspected stress injury
  25. describe the possible manifestations of fractures that arise under tensile stress or in areas of poor vascularity
  26. list the treatment requirements for high-risk fractures
  27. recall the fatigue fracture line percentage that marks fractures as high-risk
  28. state the imaging modality utilized in the classification system proposed by Fredericson et al
  29. explain the grading system for medial tibial stress syndrome as seen at MR imaging per the Fredericson et al classification system
  30. interpret Table 1 in the article in order to identify atypical femoral fractures
  31. recall what type of fractures are more likely to relate to comminution
  32. list the radiographic views recommended when an atypical femoral fracture is identified
  33. state the percentage of patients that demonstrate a fracture in the contralateral femur either at the time of atypical femoral fracture or in subsequent years
  34. list the clinical factors that may increase the risk of atypical femoral fracture
  35. recall the patient population most likely to experience pathologic fractures
  36. list where pathologic fractures most commonly occur
  37. state the best suited imaging modality for discrimination between benign and malignant fractures
  38. explain the most important marrow signal intensity related to MRI in the differentiation between benign and pathologic fracture
  39. list features that may suggest pathologic vertebral compression fractures
  40. recognize features of pathologic fractures demonstrated on multiple imaging modalities