Radiographic bone modelling and density were normal with no features to indicate an underlying disorder that might predispose the patient to fracture. However, by the time of repeat radiographs 5 weeks later, the right fracture had healed, while the left showed evidence of further interval healing (Fig. A follow-up skeletal survey was not performed. The finding of healing bilateral fibular fractures was reported as unusual, further raising the suspicion of inflicted injury. ![]() 3) at an almost identical position to the left fibular fracture. An initial skeletal survey (excluding the left leg) revealed a further healing undisplaced fracture of the right fibular diaphysis (Fig. 2) performed 2 days later because of persistent symptoms demonstrated increased periosteal reaction and the suspicion of inflicted injury was raised. An orthopaedic follow-up radiograph (Fig. The child was well cared for and there were no bruises, scratches or other stigmata of abuse.Īnteroposterior and lateral radiographs of the left leg demonstrated a subtle undisplaced fracture of the left fibula but were initially reported as normal (Fig. There was no history of illicit drug or excessive alcohol use, the family was not previously known to social services, and the boy’s immunisations were up to date. The clinical teams found nothing suspicious in the caregivers’ behaviour or social history. No other concern was reported and there was no relevant medical history of note. His caregivers persistently sought medical attention for the limited use of his left leg: He was presented to the emergency department 3 days later, and again 6 days after his initial presentation to his general practitioner. He was given a diagnosis of transient synovitis and discharged home. If the diagnosis is made early and the appropriate weight-bearing limits are applied, most stress fractures in the lower leg will heal and the athlete will be able to return to their former level of activity.A 6-month-old boy was presented to his general practitioner after his caregivers noticed that he was not holding or using his left leg in a normal manner. A smoother running style with shorter footsteps, a slower pace, and shorter sessions can help decrease symptoms. Taking dietary supplements has proven to be an effective measure in optimising bone health. For some athletes it may be useful to have a blood test to measure nutritional levels. During the non-weight-bearing period it is important to identify possible contributing factors, such as running technique, footwear, training program, and nutrition, as well as to make a plan for how to gradually increase training again. Training that doesn't involve any weight-bearing is allowed. Other times, the load on the leg can be modified using pain monitoring. Sometimes it is located in a so-called high-risk zone in which case it will be necessary to take all weight off the leg and use crutches for several weeks. Treatment of a stress fracture depends on where it is located. As such, MRI is more suitable to confirm the diagnosis. In the early stages, it is not common to see signs of a stress fracture using regular X-ray images. Sometimes the breakdown can be so great that it eventually fractures completely.Ī doctor or physiotherapist will make the diagnosis. It is important to get an early diagnosis to avoid further breakdown of the bone tissue. Sometimes, but not always, the pain can be localised to a specific point. In an early stage, the pain will subside with rest, but after a while it can continue during day-to-day activities. The main symptom is pain in the leg that gets worse during training. Low levels of calcium and vitamin D affect bone mass density and can thus increase the risk of a stress fracture. Low muscle strength and muscular endurance result in higher impacts in the joints and an increased load placed on the skeleton. Women are more prone to stress fractures than men since they have less bone mass and bone density decreases with age. There are several factors that, in combination with load, increase the risk of a stress fracture. Starting to train again following an injury or illness. ![]()
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