• AIM
    • To investigate the association of a fatigue-type stress fracture and a fibrous cortical defect/non-ossifying fibroma (FCD/NOF) of the lower limb long bones in skeletally immature patients.
  • MATERIALS AND METHODS
    • The patient database of a specialist orthopaedic oncology centre was searched to determine the number of skeletally immature patients (
  • RESULTS
    • Six percent of patients (five cases) referred to an orthopaedic oncology unit, who were subsequently shown to have a stress fracture of the lower limb long bones, were found to have a related FCD/NOF. All had been referred with a suggested diagnosis of a bone sarcoma and/or osteomyelitis. The possibility of a stress fracture had been raised in only one case. Four cases involved the proximal tibia and one the distal femur. Radiographs revealed that both lesions arose in the posteromedial cortex in all but one of the cases. The radiographs and magnetic resonance imaging (MRI) features were considered typical of the overlapping pathological features of the lesions.
  • CONCLUSIONS
    • A sarcoma could be effectively excluded in the absence of true cortical destruction and soft-tissue extension. Both fatigue-type stress fractures and FCD/NOFs occur at similar sites in the long bones. It is postulated that the existence of the latter may cause localized weakening of the bone thereby predisposing to the development of a stress fracture. The co-existence of these two conditions in the skeletally immature should be recognized as the dual pathological processes may contribute to radiological misdiagnosis.