EC Orthopaedics

Introduction: Stress fractures of tibia or fibula are rare in healthy children younger than 10 yrs. Clinical symptoms are limping and pain, usually obscure that require investigation. Radiological examination reveal cortical thickening. MRI scan reveals bone and periosteal edema that are usually confusing. Either malignancy or infection must be excluded in this age group.

Case Report: A group of 4 children, younger than 10 yrs, among those referred for pain and limping, were diagnosed as stress fractures. The initial MRI scan performed elsewhere, had extended bone edema that raised suspicion for malignancy. All children had a thorough clinical investigation with appropriate imaging with x-rays, MRI and CT scans.

Results: An accurate localization of the point of tenderness was clinically found in all children. Plain x-rays showed cortical thickening in one child. No fracture line was detected with x-rays. MRI findings were extended edema in the medullary canal and the surrounding tissues, with intact cortices. Only one child had a fracture line on the MRI scan. CT scan showed the presence of smooth periosteal elevation, with normal cortex on the affected bone. Fracture line was seen in 2 children.

Conclusion: The combination of plain x-ray, MRI and CT scan can provide appropriate information to achieve the correct diagnosis and avoid unnecessary procedures. Immobilization and restriction of weight bearing was the treatment provided that permitted healing of the fracture.

Keywords:  Stress Fracture; Tibia; Fibula; Children

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