A Toddler with Bilateral Fractures of the Fibula

Abstract

Stress fractures are uncommon, and bilateral stress fractures are rare. The diagnosis of stress fracture can be difficult as conventional radiographs usually show evidence of the fracture repair instead of the fracture. A stress fracture must be differentiated from more serious processes, particularly osteomyelitis and bone malignancies. In young children there may be no obvious cause, and imaging can greatly facilitate the diagnosis. We present a case of a toddler referred for evaluation for a possible bone malignancy but who was diagnosed with bilateral fibular stress fractures. Only one case of bilateral fibular stress fracture has been described in a toddler. However, unlike this case, our patient lacked an apparent explanation for the injury.

Bilateral fibular fractures in a pre-ambulant infant

“…This fracture pattern has been reported in a 10-month-old girl following repetitive banging of the child's walker (supported ambulation) against a kitchen cabinet with her lower legs at the level of the fractures [7]. They have also been described in a 26-month-old boy, for whom there was no history of trauma or other apparent explanation [4]. We acknowledge that there is no proof of our proposed hypothesis.…”

“…Stress fractures result from repetitive low-grade forces, each insufficient to cause a fracture but cumulatively weaken both the bone and the overlying muscle, eventually leading to fracture. Fibular stress fractures result from repetitive injuries, usually in ambulant athletic younger children and adults: It is thought that in toddlers, they result from the novel stresses associated with new/developing ambulation [4].…”