title: Three different stages of bone stress reactions of long bones in one patient: case report and review of the literature.
abstract: BACKGROUND
  The similar clinical and radiological early course of stress fractures and bone tumors can lead to diagnostic misinterpretation.
  
  
  METHODS
  A patient is presented who was admitted to our clinic with the diagnosis of similar bone tumors in the distal femur and the proximal tibia. We found an additional localization with high bone turnover in the contralateral proximal tibia; including this lesion, the patient presented with three different types of stress reaction of bone. The final diagnostic decision-making was based on MRI and bone scintigraphy as well as the consideration of localization, age of occurrence, and behavior of malignant bone diseases. Therefore, bone biopsy was not performed.
  
  
  RESULTS
  After 8 weeks of partial weight-bearing, the symptoms disappeared, and the patient could return to normal activity.
authors.affiliation: Department of Trauma and Reconstructive Surgery, Charité Campus Virchow, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. hermann.bail@charite.de
authors.forename: Hermann J
authors.initials: HJ
authors.lastname: Bail
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Schaser
authors.forename: Michael
authors.initials: M
authors.lastname: Raschke
authors.forename: Ingo
authors.initials: I
authors.lastname: Melcher
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis*; D005264:Femoral Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015775:Fractures, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011877:Radionuclide Imaging; D013977:Tibia; D013978:Tibial Fractures / Q000175:diagnosis* / Q000000981:diagnostic imaging