Stress Fractures In Children Research Articles

Fractura de estrés sucesiva bilateral del 5th metatarsiano, en niño con metatarso aducto.

Stress fractures of the lateral column of the foot are rare and almost always in the context of competitive sports. Stress fractures in children are even less frequent and are most often seen in cases of associated foot deformities, especially pes cavus varus or metatarsal adductus. We present the case of an 11-year-old boy with stress fractures of the fifth metatarsal of both feet with bilateral metatarsus adductus deformity. We recall the relative frequency of residual metatarsus adductus deformity in the older child, the greatly increased risk of stress fractures of the external column of the foot associated with this deformity, as well as refractures and nounion. Finally, to recall the signs and symptoms of metatarsus adductus deformity, as well as the radiographic aspects related to this fracture considering its rarity in children.

Calcaneal stress fracture diagnosed by MRI

Abstract This case report demonstrates a paediatric calcaneal stress fracture not seen on traditional radiograph but diagnosed by MRI. A young athlete presented at age 15 with heel pain and no trauma. Calcaneal stress fractures in children are rare and could be underdiagnosed since radiographs are often false negative especially in the early stages. Therefore, calcaneal stress fractures with a normal radiograph could be misclassified as Server's injury. The treatment strategy for a calcaneal stress fracture is more aggressive than for Server's injury and therefore distinction towards a stress fracture is important to choose the optimal treatment. Consequently, when a child presents with acute limp, refusal to walk and/or heel pain, with no evident trauma and negative radiographs further investigation is needed. We propose performing a bone scintigraphy or MRI to avoid overlooking stress fractures of the calcaneus and misclassify these fractures as Sever's injury.

Is the incidence of paediatric stress fractures on the rise? Trends in New York State from 2000 to 2015.

The purpose of this study is to analyze trends in the epidemiology of paediatric stress fractures. The New York Statewide Planning and Research Cooperative System database was queried for stress fractures in children between the ages of 6 and 18 years. After checking for monotonicity of the data, Spearman's correlation coefficient was calculated. Multivariate regressions were used to test for associations between demographic variables and risk of stress fracture. Analysis of 11 475 386 outpatient visits between 2000 and 2015 showed that the annual incidence of paediatric stress fractures increased from 1.37 cases per 100 000 outpatient visits in 2006 to 5.32 per 100 000 visits in 2015 (ρ = 0.876, P < 0.01). The mean age at the time of injury was 14.4 ± 2.8 years. Children younger than 14 years accounted for 33.6% of the cohort. Age, male sex, white ethnicity, and private insurance were statistically significant predictors of stress fractures in a multivariate model. This study is the first to document an increase in the annual incidence of paediatric stress fractures.

Failing Bones in the Youngest Athletes: 217 Cases of Stress Fractures in Children 8-14 Years Old

Failing Bones in the Youngest Athletes: 217 Cases of Stress Fractures in Children 8-14 Years Old

Stress fractures in children

Presentation of own experiences, observations and results of treatment of patients with stress fractures treated in the Department of Paediatric Orthopaedics. The authors present an algorithm of diagnosing and treatment of stress fractures. Over the period 1998 - 2010, 38 patients were hospitalised (40 fractures) with the final diagnosis of stress fracture. Personal patients' data, case histories and management preceding the diagnosis of the disease, diagnostic and therapeutic methods, as well as the results of treatment were collected on the basis of medical documentation. Standard diagnostic procedure consisted of: clinical and radiological examination, laboratory tests as well as computed tomography (CT). In 11 cases, the procedure included also scintigraphy and in two children MRI scan was performed. Complete healing of fractures was finally achieved in all patients In case of suspected stress fracture, it is necessary to perform a series of radiograms, which should present the picture of bone rebuilding and incorporation of the periosteal callus. If plain radiograph is inconclusive we should consider MRI , CT or scintigraphy scan. The results of laboratory tests should not show any abnormalities. In case of confirmed stress fracture nonweight-bearing of the affected extremity is recommended as well as introducing of close clinical-radiological monitoring. The results of MRI examination should be interpreted very cautiously, be cause it can be misleading. The observation strategy (“wait and see”) should be implemented. However, the lack of the regression of pain sensation, bone rebuilding features and incorporation of periosteal callus or the appearance of visible bone destruction (lysis) should raise questions and present an indication for taking biopsy of the laesion.

Stress fractures of ankle and wrist in childhood: nature and frequency

Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain.

Fatigue fracture of the sacrum in an adolescent

There are relatively few reports of sacral stress fractures in children. In adolescents, sacral stress fractures have been reported in patients involved in vigorous athletic activity. Recognition of these fractures is important to avoid unnecessary biopsy if the findings are confused with tumor or infection. We report a sacral fatigue fracture in a 15-year-old without a history of athletic participation or trauma.

Pediatric stress fractures.

Stress fractures in children are uncommon. This report describes the findings of 8 cases in 6 children. One patient had 3 stress fractures: 2 consecutive midshaft stress fractures of the same tibia associated with one of the fibula. Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Serial radiographs and computed tomography scans are the key to the diagnosis, although bone scan and magnetic resonance imaging can be helpful. Biopsy is unnecessary and might even be misleading.

Stress fractures in a hyperactive 3-year-old girl

A 3-year-old girl was admitted to hospital on June 28, 1996, after a week’s pain in the left leg and a limp. She was not feverish. There was no history of trauma nor of family history of joint disease or bleeding disorder. She was unusually active, being on the move all the time. Examination was inconclusive as she was uncooperative, but she had no restriction of joint movements, although it was clear that her left leg was giving way when she walked. Her limp became steadily worse over the next week. Investigations showed a normal white blood count and an erythrocyte sedimentation rate of 10 mm/h. Radiographs of her left tibia and fibula showed a faint but definite periosteal reaction at the proximal tibial metaphysis. Re-examination showed no tenderness at this site. An isotope bone scan on July 4 showed “intense increased uptake in the proximal third of the left tibia” which, taken with the periosteal reaction, is typical of a stress fracture. By Aug 21, there was mature callus formation at the fracture site (figure). By Oct 24 she had no localised tenderness, but was still limping at times although extremely active; repeat radiographs showed remodelling of the previous stress fracture; quite unexpectedly there was a new healing fracture of the proximal third of the left fibula surrounded by callus. Stress fractures in children are uncommon especially under 5 years; fractures of the tibia are commonest, the usual site being the proximal followed by the distal shaft, followed by the fibula. Hitchens and Lyons noted a fatigue fracture of the medial malleolus in a 9-year-old female roller skater. Sheehan et al reported bilateral fibular stress fractures in a 10-month-old girl due to use of an infant walker; it was thought that repeated sub-acute trauma due to banging her walker into the kitchen cabinets, with consequent transfer of energy to the crossbar and thence to each fibula, was the mechanism. The common factor appears to be continued sudden violent repetitive activity. No such predisposing factors could be found in this patient, apart from her unusual activity.

Stress fractures of the fibula in the first few years of life (report of six cases).

Fibular stress fractures in children in the first few years of life are not well known and are often confused with osteomyelitis or malignant bone tumour. This misdiagnosis is followed by nuclear scan, computerized tomography (CT), magnetic resonance (MR) imaging and even biopsy. All these investigations are unnecessary as plain X-rays show diagnostic radiographic findings and misdiagnosis is highly unlikely when they are evaluated in the context of clinical findings.

Streßfrakturen im Kindes- und Jugendalter

Etiology, epidemiology and topographic findings of stress fractures in children are shown in our retrospective study (1976-1994). Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Stress fractures in children may result from normal activities and are located mostly at the proximal tibia. Conventional X-ray and -tomography are the goal in diagnostic. Typical radiological findings are demonstrated by case reports.

Femoral stress fractures in children

Stress fractures reported in the medical literature almost exclusively affect young athletes, military recruits and patients with metabolic bone disease. The classification of stress-induced bone injury is somewhat confused and includes "fatigue" stress fractures which occur in previously normal bones and "insufficiency" stress fractures which occur in bones weakened by various causes. Femoral stress fractures in children are extremely rare, and we report 5 cases in young patients who sustained their injuries during the course of normal play activities. It is well-known that these lesions can simulate malignant lesions; however, we believe that careful review of the radiographs in the context of the clinical history can in many cases lead to the correct diagnosis being made and obviate the need for further intervention.

Stress fractures in young athletes.

In a series of 16 cases of stress fractures in 15-year-old and younger athletes 8 fractures occurred in boys and 8 in girls. There were no differences between the sexes in the athletes' training habits. Ten of the fractures were located at the tibia, seven at its upper third and three at the lower part of the bone. Three fractures were found in the fibula, in the metatarsal bones two stress fractures and in the femur one stress fracture. Most stress fractures were caused by endurance type sports. The daily training distances were not particularly high at the time of the onset of the symptoms. In most cases the diagnosis was based on a radiological evaluation. A sufficiently long pause from all athletic activity was enough treatment. Stress fractures in children are very uncommon.