Baker Jonathan C, Demertzis Jennifer L
Mallinckrodt Institute of Radiology, Musculoskeletal Section, Washington University School of Medicine, 510 S. Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA.
Skeletal Radiol. 2016 Jun;45(6):833-7. doi: 10.1007/s00256-016-2357-z. Epub 2016 Mar 15.
In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture.
与广泛报道的胸骨不全骨折不同，过度使用导致的胸骨应力性骨折极为罕见。在英文医学文献中发表的5例胸骨应力性骨折病例中，3例位于胸骨体，仅2例位于胸骨柄。我们描述了2例与高尔夫运动和举重相关的胸骨柄应力性骨折病例，并首次报告了该损伤的磁共振成像（MR）表现。在每例病例中，疼痛起病无外伤史，隐匿性发作，且与体育活动频率增加有关。因临床诊断存在不确定性而行影像学检查。磁共振成像显示，每位患者在与第一肋软骨结合处相邻的胸骨柄外侧均有矢状位方向的应力性骨折。两名患者经过一段时间的休息后疼痛均缓解，随后成功恢复各自的活动。其中一名患者接受了随访磁共振成像检查，结果显示胸骨柄骨髓水肿和骨折线消失。基于胸骨解剖结构和磁共振成像表现，我们推测这种罕见损伤可能是由于第一肋软骨和胸骨柄上肌肉力量的反复扭转所致，并提出磁共振成像可能是诊断胸骨柄应力性骨折的有效手段。
