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Virtual Pediatric Hospital: Paediapaedia: Fracture, Stress Paediapaedia: Musculoskeletal Diseases

Fracture, Stress

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Localized pain that subsides with rest and a limp. The symptoms can be chronic and the pain may be referred.

Etiology/Pathophysiology:
A fracture of normal bone which has been subjected to a repeated stress which is not sufficient to create a complete fracture. The fracture begins as a small cortical infraction that progresses as stress increases or continues.

Pathology:
Not applicable

Imaging Findings:
The proximal tibia is the most common site followed by the femur, fibula, and ischium. A bone scan is best for early diagnosis, showing positive findings 2-3 weeks before the plain films show changes. The earliest plain film changes are cortical bone resorption or infraction at the fracture site with accompanying periosteal reaction. The lucent fracture line is often difficult to see. A transverse sclerotic line may be seen near the fracture site

DDX:
Sclerosis with periosteal reaction:

References:
See References Chapter.

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