Stress Fractures of the Femoral Diaphysis in Young Children

Abstract

Stress fractures of the femoral diaphysis in young children are rare. Pain and an antalgic gait are the most common features. There is usually no history of either trauma or a recent increase in physical activities. Initial radiographs may be normal. Technetium bone scanning is the most sensitive method of early diagnosis, but may not be diagnostic. Computed tomography and magnetic resonance imaging are useful in early confirmation of the diagnosis. Serial radiographs will show maturation of the periosteal new bone with evidence of repair. Biopsy should be avoided, except in cases of obvious neoplasm shown by computed tomography or magnetic resonance imaging, or in cases with progressive cortical destruction shown on serial radiographs, because fracture callus may be difficult to distinguish from osteosarcoma. Treatment consists of protected weight bearing and activity restriction until resolution of symptoms and radiographic evidence of healing.