|
Year |
2002 |
|---|---|
|
Question Number |
11 |
|
Category |
Pediatric Orthopaedics |
Question
A 6-year-old boy sustained a mildly displaced closed fracture of the left proximal tibia and fibula. His parents report that prior to the fracture he had no symptoms or medical problems. The patient has no pain or fever, and examination reveals no tenderness, swelling, or palpable mass at the fracture site. Radiographs obtained at the time of injury show no lytic lesions. Figure 1 shows a follow-up radiograph obtained at the time of cast removal. The next most appropriate step in management should be
1- observation with repeat radiographs in 6 weeks.
2- needle aspiration for culture of the fracture site.
3- open biopsy and curretage of the lesion.
4- a skeletal survey.
5- MRI of the tibia.
Figures
Answer (click for answer)
Correct Answer: 1- observation with repeat radiographs in 6 weeks.
The figure shows an X-ray of the left proximal tibia/fibula with a well-demarcated cystlike cortical defect in the proximal tibia. The referenced article reports the development of similar cystlike cortical defects . Apparently these defects can appear after greenstick fractures in children. They are typically asymptomatic and appear just proximal to the fracture line within the area of subperiosteal new bone formation. The cause of these defects is unknown. They usually completely resolve without any effect upon the fracture healing. At the time of this paper, only twenty cases, including the two from this paper, had been reported in the English-language literature.
Reference: J Pediatr Orthop 2001;21:9-13.