Stress Fractures of the Femoral Diaphysis in Children

Abstract

The authors report five new cases of the stress fracture of the femoral diaphysis in children. These injuries usually occurred without a history of recent increase of activity. Recently regained normal activity after long-term immobilization and a fibrous cortical defect were predisposing factors. The periosteal reactions were usually identified in the initial radiograph and were not confined to the medial cortex of the distal femur; they might occur in any part of the femoral diaphysis, and also concomitantly on the multiple cortex. The atypical radiographic presentations frequently required MRI for differential diagnosis. Even though the MRI may be confusing to the inexperienced observer, it can lead to the diagnosis of a stress fracture with confidence, negating the need for biopsy. Clinicians should be aware of this diagnostic entity in the differential diagnosis of femoral diaphyseal lesions in children because the occurrence might be more common than reported. Serial simple radiographic examinations taken at intervals to look for the evidence of progressive fracture healing and the restriction of activity or immobilization may be an adequate approach for management.

A Non-ossifying Fibroma and a Stress Fracture of the Femur Mimicking Bone Malignancy in a Child

“…According to Easley and Kneisl (1997), lesions affecting more than 50% of the bone diameter could predispose to fracture [8]. It should be pointed out that a femoral pathological fracture on a pre-existing NOF is rare [9]. In our case, the pathological fracture could be accepted as an insufficiency fracture.…”

Distal Femoral Stress Fractures Has High Operation Rates in Adolescent and Young Adult Athletes

“…Shortly thereafter, Lee and colleagues described 5 cases of diaphyseal femoral lesions in preadolescent children that were ultimately diagnosed as stress reactions. 3 The current series presents the largest cohort of young athletes with a diagnosis of distal femur stress fractures in the literature to date. Careful review of the literature reveals key aspects of a patient's history that can help primary care providers and orthopaedic surgeons alike correctly diagnose and treat distal femoral stress fractures.…”

“…Plain films may demonstrate a periosteal reaction along the medial or posteromedial cortex of the distal femur metadiaphysis (which may progress to other cortices in the healing phase) or may be normal. 3 In patients treated nonoperatively, initial plain films were read as normal in 80% of patients. Since radiographs lack sensitivity in early disease, negative initial radiographs should not preclude advanced imaging in high-risk populations like endurance runners, jumpers, and dancers at initial presentationespecially in the setting of recalcitrant activity-related knee pain that resolves during a period of rest and resumes upon return to previous high-level of physical activity.…”

“…Key Words: distal femur, stress fractures, knee pain, overuse injury, adolescents, athletes, military training, vitamin D deficiency (J Pediatr Orthop 2024;44:e439-e445) W hile femoral stress fractures-typically involving the femoral neck-represent 10% of overuse injuries in the active adolescent population, 1,2 stress fractures of the distal femoral metaphysis are sparsely reported in the literature. [2][3][4][5][6] Although exceedingly rare, symptoms may be incorrectly attributed to knee pathology in the adolescent athlete, which may lead to a delay in diagnosis and treatment. Missed or completed fractures can result in high morbidity in otherwise healthy adolescents and young adults.…”

“…While femoral stress fractures—typically involving the femoral neck—represent 10% of overuse injuries in the active adolescent population, 1,2 stress fractures of the distal femoral metaphysis are sparsely reported in the literature 2–6 . Although exceedingly rare, symptoms may be incorrectly attributed to knee pathology in the adolescent athlete, which may lead to a delay in diagnosis and treatment.…”