Distribution and natural history of stress fractures in U.S. Marine recruits.

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Abstract
In a prospective study, 839 scintigraphic abnormalities that could be related to stress were detected in 250 patients (23% cortical; 77% cancellous). Only 28% had confirmatory radiographs. Of 73 patients with 2-6-wk follow-up, 54% showed radiographic changes. The fractures showed definite patterns of scintigraphic and radiographic evolution dependent upon location and exercise program. Recruits with a running background suffered fewer fractures. A regular sequence of radiographic changes in cancellous bone, presumably not previously noted, includes an initial normal radiograph progressing to subtle speckles of calcium density which finally coalesce into the sclerotic band typical of cancellous bone stress fracture. In the appropriate clinical setting, a scintigraphic abnormality is diagnostic of stress fracture even if radiographs are normal.