Dirk Schaper, V. Hofmann (Halle/S.)  

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8 Years  

Female  

Leg-Bones  

physical  

8 year old turk girl with pain in the right tibia for about 14 days. No trauma could be remembered. No nightly pain. When stressed, pain began and worsening. Discrete pasty swelling over the right proximal tibia. Local pain on pressure, no redness. No inflammatory/infectious clinical signs.  

N/A  

<- view X-Ray 1

X-ray 1: Lower thigh in two planes, no signs of fracture, discrete opaque bands in the proximalen tibia.






<- view X-Ray 2

X-ray 2: Lower thigh a. p.: After 14 more days, spindle-shaped callous, horizontal opaque band with dispersed bone structure






<- view MRI 1

MRT 1: In the T1 weighted image, expanded zone of reduced signal, inhomogenic spotty signal reduction, strongly inhomogenic signal increase in T2. Hypodense interruption of the bone's contour. Distinct soft-tissue edema.



 

Total constellation (Consens)  

Osteomyeltitis, Bone tumor  

After bed rest, condition improved. No further symptoms. Normal gait.

A stress fracture in children is rather uncommon. The tibia is often seen, followed by the mid-foot bones, femur, fibula and pelvis. This is more common in females. Typically, the slow progression of pain over a longer period of time is seen. Mostly athletes are afflicted.
X-ray diagnostics with conventional images is often not sufficient, especially since Osteomyelitis and bone tumors must be excluded differentially. An MRI makes sense and allows staging.
Therapy depends on the degree of the damage, the time of diagnosis as well as the localization. It spans from bed-rest to surgical repair.  

Because of the clinical and laboratory course as well as the obvious placement as a Grade 4 lesion in MRI, we found this to be a stress fracture and treated it conservatively.  

N/A  

1. Medline:
Fredericson, M., Bergmann,A.G., Hoffmann,K.L. et al.
Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.
Am J Sports Med 23 (1995) 472-481

2. Medline:
de la Cuadra, P., Albinana,J.
Pediatric stress fractures
Int Orthop 2000;24(1):47-9

3. Medline:
Mitchell,A.D., Grimer,R.J., Davies,A.M.
Double-stress fracture of the tibia in a ten-year-old child.
J Pediatr Orthop B 1999 Jan;8(1):67-8  

Stress fracture, swelling, increasing leg pain, fracture, proximal tibia, child, childhood, pediatric radiology  

Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
URL: www.PedRad.info/?search=20030603161946