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Radiology Research and Practice
Volume 2013, Article ID 370169, 10 pages
Review Article

Radiographically Occult and Subtle Fractures: A Pictorial Review

1Department of Radiology, Musculoskeletal Section, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA
2Department of Radiology, University of Erlangen, 91054 Erlangen, Germany
3Department of Radiology, Hospital do Coração sp (HCor) and Teleimagem, 04004-030 São Paulo, SP, Brazil
4Department of Radiology, VA Boston Healthcare System, Boston, MA 02130, USA
5Department of Radiology, Seattle Cancer Care Alliance, University of Washington, Seattle, WA 98109, USA
6Department of Radiology, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar

Received 24 December 2012; Accepted 20 February 2013

Academic Editor: Andreas H. Mahnken

Copyright © 2013 Mohamed Jarraya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Radiographically occult and subtle fractures are a diagnostic challenge. They may be divided into (1) “high energy trauma fracture,” (2) “fatigue fracture” from cyclical and sustained mechanical stress, and (3) “insufficiency fracture” occurring in weakened bone (e.g., in osteoporosis and postradiotherapy). Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Early detection of these fractures is crucial to explain the patient’s symptoms and prevent further complications. Advanced imaging tools such as computed tomography, magnetic resonance imaging, and scintigraphy are highly valuable in this context. Our aim is to raise the awareness of radiologists and clinicians in these cases by presenting illustrative cases and a discussion of the relevant literature.