de Pina Carlos Aguiar Ramos, Balacó Inês, Serrano Pedro Ruas, Matos Gabriel
Orthopedic Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Orthopedic Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.
BMJ Case Rep. 2015 Feb 16;2015:bcr2014206972. doi: 10.1136/bcr-2014-206972.
Fibula fractures are the third most common stress fractures in children and adolescents. The triad of localised periosteal reaction, endosteal thickening and radiolucent cortical lines, localised in the distal third of the fibula along with a typical clinical history is in most cases sufficient to establish the diagnosis. Proximal fibula stress lesions are a very rare finding, with few reports in the literature. Stress fractures in this location demand careful investigation before a definitive diagnosis can be made. In the presence of non-specific MRI findings, stress fracture should be a diagnosis of exclusion. The authors report a case referred to their department by a sports medicine physician with a suspicion of stress fracture of the proximal fibula without characteristic imaging findings, which was ultimately confirmed as a stress lesion only by biopsy.
腓骨骨折是儿童和青少年中第三常见的应力性骨折。局限性骨膜反应、骨内膜增厚和透亮皮质线三联征，位于腓骨远端三分之一处，结合典型的临床病史，在大多数情况下足以确诊。腓骨近端应力性损伤非常罕见，文献报道很少。这个部位的应力性骨折在做出明确诊断前需要仔细检查。在MRI表现不特异的情况下，应力性骨折应作为排除性诊断。作者报告了一例由运动医学医生转诊至其科室的病例，怀疑是腓骨近端应力性骨折，但没有特征性影像学表现，最终仅通过活检确诊为应力性损伤。
