Stress Fracture in Childhood

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STRESS fracture in childhood is a relatively rare injury, apparently only 71 cases having been reported in the English literature to 1963.1 The entity is also recognized by the name ‘fatigue fracture,’ or, in the special case of the foot, ‘march fracture.’ According to Meyerding and Pollack, 2 in 1855 Breithaupt described the complication occurring in soldiers after long marches. In 1897, soon after the advent of roentgenograms, the stress injury was demonstrated to be a hairline fracture.

An early description of stress fractures in children is that of Roberts and Vogt3 in 1939 Their report concerned 12 children each with a painful limp and no history of trauma. All of the children subsequently proved to have fractures involving the upper third of the tibia a few inches below the epiphysis. In a recent paper by Devas, 1 stress fractures are reported as having occurred in the tibia, fibula, humerus, rib, pelvis, sesamoid bones, metatarsals, and femora of children up to 16 years of age. In the “series of more than 40 patients,” it was noted that the tibia was the bone most commonly fractured in children. The child usually has a painful limp of gradual onset, avoids the bearing of weight, and feels most comfortable when at rest. Examination reveals some swelling around the area of fracture (usually the upper tibia) accompanied by tenderness up and down the shaft.

Limp in children often poses a problem of differential diagnosis, especially if there is no history of trauma. The little-known . . .



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