Longitudinal stress fractures of the tibia: diagnosis with CT

In most cases, the diagnosis of stress fracture is straightforward with a history of physical activity; characteristic pain in a specific site; and plain radiographs that show sclerosis, periosteal or endosteal reaction, no abnormalities, or, rarely, a fracture. However, when any of the features above are atypical, further study is warranted. Most stress fractures of the tibia are transverse or oblique and involve the mid or proximal shaft. Two cases are presented in which the fracture line was seen on computed tomography scans as coursing longitudinally down the shaft of the distal tibia, which, to my knowledge, is an orientation and location not previously described in the literature.