Clinical significance of nonfocal scintigraphic findings in suspected tibial stress fractures

The clinical significance of nonfocal increased uptake on skeletal scintigraphy in suspected tibial stress fractures is controversial, because it may represent either bone reaction to stress or a stress fracture in evolution. The scintigraphic evolution of areas of abnormal tibial activity, graded according to a 1 to 4 rating system and their corresponding clinical courses, were analyzed in 27 military recruits, as part of a prospective study. Disappearance of pain correlated with scintigraphic healing and increased pain with progression to stress fracture. Decreased or persistent pain had equivocal scintigraphic correlation. Eight of 14 nondiscrete scintigraphic lesions disappeared in spite of continuous training by the recruits; four such lesions, however, progressed to stress fractures. This uncertainty of progression suggests that military recruits and people training for sports who have such scintigraphic activity should have a brief rest period and proper monitoring before resuming training.