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Periosteal elevation in a 2 1/2-year-old child.

History A 2 1/2-year-old boy complained of pain below the knee and had diffculty walking. Initial examination showed pain and redness over the right proximal tibia. The patient had a low-grade fever. The white blood cell count was 11,000/cu mm. Figure 1 was obtained soon after onset; Fig 2 and 3, three weeks later. Diagnosis Stress fracture. Comment The initial roentgenogram (Fig 1) showed no positive findings. Roentgenograms made three weeks later (Fig 2 and 3) showed periosteal elevation with subperiosteal new bone and a sclerotic line crossing the proximal tibia, indicating a healing fracture. Stress fractures occurring in young adults, especially military recruits, have been described in the literature as early as the mid-19th century. 1 Similar fractures in children younger than 10 years old have rarely been recorded. Often, the clinical findings and roentgenographic appearance lead to an erroneous diagnosis of either tumor or inflammation in these children.