PMC4898002_01
26-month-old boy with limp. AP radiograph of right tibia and fibula is normal.
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Conventional radiographs revealed no abnormalities (Figure 1).
26-month-old boy with limp. Delayed image of nuclear bone scan demonstrates focal abnormal activity in the mid-diaphysis of each fibula (arrows). Activity about the joints is normal.
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A bone scan demonstrated distinctly increased activity in the mid-fibular diaphysis bilaterally (Figure 2).
26-month-old boy with limp and subsequent fall. A, Sagittal TI-weighted (383/a) spin echo MRI of left fibula demonstrating a fracture line (curved arrow). B, Sagittal proton-density weighted (2500/29) fast spin echo (ETL6) MRI of the left fibula again demonstrating the fracture line (curved arrow) as well as periosteal elevation (arrowheads). This appearance is quite diagnostic of fracture.
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A fracture line was also seen on the saggital view (Figure 3).
PMC4898002_02
28-month-old boy with previous limp and fall. Follow-up conventional radiographs two months after the MRI demonstrate periosteal new bone (arrow) buttressing the lateral cortex of the fibular diaphysis. The fibulae are slightly bowed medially as seen on AP views of the left (A) and right (B) tibial and fibula. Lateral view of the right tibia and fibula (C) and AP view of the left tibia and fibula also show a faint disruption of the outline of the previous cortex at the presumed site of fracture (arrows).
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In addition, there was a faint fracture line through the involved cortex of the right fibula (Figure 4).