Proximal fibular stress fractures in children and adolescents, what should we rely on? Lessons learned from a case.

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. 2015 BMJ Publishing Group Ltd.