Stress Fractures in Children.

1 Case 1-A boy aged five developed a limp in his left leg two to three weeks before being seen, with no history of injury. There was swelling and tenderness over the upper end of the left tibia, and the radiograph showed a typical compression stress fracture of the upper tibial shaft. The internal and external callus is well shown. The pattern of stress fractures in the adult is different from that in children, in whom the clinical course, the radiographic features and the site of the lesion merit separate description. The region of the knee is particularly affected and the type of lesion varies with the age of the child. It is important to emphasise that a stress fracture in a child may resemble an infective or malignant condition, and when there is difficulty in diagnosis a biopsy must be done. This paper is based on over forty stress fractures in children up to the age of sixteen years. Well before this age, however, some stress fractures behave like those in the adult and these will not be discussed in detail. That the clinical and radiological findings in a child with a stress fracture differ from those in an adult can, in part, be explained by the greater tendency of young bone to bend, as well as by the richer blood supply of a growing bone. How the stresses to which the bones of children are subjected in normal day-today activities differ from those ofan adult cannot readily be answered, but it is unimportant in relation to diagnosis and treatment. The profuse callus that a child produces may extend some way up and down the shaft of a long bone. This callus may be entirely under the periosteum, which is raised from the bone but remains intact. The periosteal stripping might be expected to be painful, but no relationship has been found between the amount of subperiosteal callus and the severity of the pain. In young children the callus may be so profuse as to suggest infantile cortical hyperostosis. It is important in diagnosis to recognise the sites at which stress fractures are common, both from those recorded in the literature-which are not very many-and in this series. There have been several accounts of stress fractures which have included children, but only a few devoted to any particular bone, and none dealing with the problem as a whole. Tables …