Pseudofracture is a radiological finding which has an appearance similar to a fracture line but is not a fracture in true sense. That is why it is called pseudofracture [pseudo in Greek means false]. However, some authors consider it to be a form of insufficiency type of stress fracture.
A pseudofracture appears as a lucent area on radiographs that is oriented at right angles to the cortex and extends from the surface across the diameter of the bone.
Sclerosis frequently is found between bones, and callus-like new bone is observed at the periosteal margin.
Pseudofractures are typically found in the axillary margins of the scapula, ribs, pubic rami, proximal ends of the femoral bone and ulna.
These are known as regions of predilection are in patients of osteomalacia. They represent infractions of the bone caused by abnormal stresses and strain.
Pseudofractures are also called as Looser Zones and represent deficient mineralization.
They were first described by Milkman in patients of osteomalacia and have come to be known as Milkman’s syndrome.
Pseudofractures have typically been associated with osteomalcia and are typically bilateral in this disease. Though they are called to be pathognomic of osteomalacia, peudofractures like shadows have been noted in other conditions as well.
There is controversy whether the shadows in these diseases are actually pseudofractures or different entity with similar appearance] reported in in following diseases
- Early and late osteogenesis imperfecta
- Paget’s disease,
- Adrenal-pituitary bone dystrophy
- Congenital syphilis,
- Certain blood dyscrasias.
Because pseudofractures themselves are without symptoms, they may be found in xrays done in cases of osteomalacia. They could be an incidental finding in persons seeking advise for some other diseases.
Pseudofractures can lead to complete fractures.
Treatment of osteomalacia with vitamin D3 and calcium would lead to resolution of these pseudofractures though they may persist for some months after the blood levels have been corrected.