{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:20:58Z","timestamp":1774610458469,"version":"3.50.1"},"reference-count":9,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Mid-fibular stress fractures are rare in the pediatric population and frequently present a diagnostic dilemma due to their subtle clinical presentation. In young, active children, the localized pain and associated periosteal reaction can closely mimic aggressive pathologies, such as primary bone malignancies or osteomyelitis, often leading to unnecessary parental anxiety and invasive diagnostic procedures. We report the case of a 4-year-old boy presenting with a 2-week history of an antalgic gait and localized tenderness over the left fibular shaft in the absence of acute trauma. While initial plain radiography revealed a reactive cortical lesion suspicious for malignancy, subsequent cross-sectional imaging with computed tomography and magnetic resonance imaging identified a subtle fracture line and circumferential periosteal thickening, confirming a mid-fibular stress fracture. The patient was managed conservatively with restricted weight-bearing and analgesics, with complete clinical recovery and radiographic bone remodeling documented at 2-month follow-up. This case underscores the necessity of maintaining a high index of suspicion for stress-related injuries in the pediatric population, even in the absence of a high-impact mechanism. A comprehensive diagnostic approach utilizing multimodal imaging is essential to differentiate benign stress fractures from more ominous conditions, ensuring appropriate conservative management and avoiding the risks associated with unnecessary biopsy or over-treatment.<\/jats:p>","DOI":"10.1177\/2050313x261430645","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T01:30:26Z","timestamp":1774315826000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibular mid-shaft stress fractures in a 4-year-old child: A case report and literature review of the first decade of children with fibular stress fracture"],"prefix":"10.1177","volume":"14","author":[{"given":"Suliman Abdullah","family":"Shurbaji","sequence":"first","affiliation":[{"name":"Pediatric Orthopedic Consultant, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6854-064X","authenticated-orcid":false,"given":"Abdulaziz Ahmed","family":"Munshi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdulaziz Ahmed","family":"Abdulaziz","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, King Faisal Medical Complex, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haneen Osama","family":"Hafiz","sequence":"additional","affiliation":[{"name":"Hand Orthopedic Consultant, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas Saeed","family":"Almoabbdi","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Alnoor Specialist Hospital, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Hosny","family":"Awad","sequence":"additional","affiliation":[{"name":"Orthopedic Department, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Bennell KL Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997; 16: 179\u2013196. https:\/\/doi.org\/10.1016\/S0278-5919(05)70016-8.","DOI":"10.1016\/S0278-5919(05)70016-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Daffner RH Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol 1992; 159: 245\u2013252. https:\/\/doi.org\/10.2214\/ajr.159.2.1632335.","DOI":"10.2214\/ajr.159.2.1632335"},{"key":"e_1_3_2_4_2","unstructured":"Aguiar Ramos de Pina C Balac\u00f3 I Ruas Serrano P et al. Proximal fibular stress fractures in children and adolescents what should we rely on? Lessons learned from a case. BMJ Case Rep 2018; 2018: bcr2017223455. https:\/\/doi.org\/10.1136\/bcr-2017-223455."},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Jaimes C Jimenez M Shabshin N et al. Taking the stress out of evaluating stress injuries in children. Radiographics 2012; 32: 537\u2013555. https:\/\/doi.org\/10.1148\/rg.322115022.","DOI":"10.1148\/rg.322115022"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Kozlowski K Urbonaviciene A. Stress fractures of the fibula in the first few years of life (report of six cases). Australas Radiol 1996; 40: 261\u2013263. https:\/\/doi.org\/10.1111\/j.1440-1673.1996.tb00399.x.","DOI":"10.1111\/j.1440-1673.1996.tb00399.x"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"de la Cuadra P Albi\u00f1ana J. Pediatric stress fractures. Int Orthop 2000; 24: 47\u201349. https:\/\/doi.org\/10.1007\/s002640050012.","DOI":"10.1007\/s002640050012"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Interiano RB Malkan AD Loh AHP et al. Initial diagnostic management of pediatric bone tumors. J Pediatr Surg 2016; 51: 981\u2013985. https:\/\/doi.org\/10.1016\/j.jpedsurg.2016.02.068.","DOI":"10.1016\/j.jpedsurg.2016.02.068"},{"key":"e_1_3_2_9_2","unstructured":"Murphey MD Senchak LT Mambalam PK et al. From the archives of the AFIP: Eosinophilic granuloma and Langerhans cell histiocytosis. Radiographics 2000; 20: 233\u2013260. https:\/\/doi.org\/10.1148\/radiographics.20.1.g00ja05233."},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Griffiths AL. Fatigue fracture of the fibula in childhood. Arch Dis Child 1952; 27: 552\u2013557. https:\/\/doi.org\/10.1136\/adc.27.136.552.","DOI":"10.1136\/adc.27.136.552"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261430645","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X261430645","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X261430645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:47:07Z","timestamp":1774608427000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X261430645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":9,"alternative-id":["10.1177\/2050313X261430645"],"URL":"https:\/\/doi.org\/10.1177\/2050313x261430645","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X261430645"}}