title: Femoral diaphyseal stress fracture as the initial presentation of acute leukaemia in an adolescent.
abstract: A 14-year-old boy was referred to the orthopaedic clinic by his general practitioner, reporting of a 6-week history of left thigh pain. Clinical examination was unremarkable. Radiographs demonstrated a periosteal reaction at the proximal femur. MRI scans demonstrated a stress fracture of the femur, with no associated sinister features and no evidence of a pathological lesion. As the fracture healed and symptoms improved, the patient became unwell with weight loss, lethargy, chest and jaw pain and fevers. After multiple blood tests over a 25-day period, including five full blood counts and two normal blood films, a third blood film finally demonstrated blasts in keeping with acute leukaemia. We discuss a literature review of musculoskeletal manifestations of leukaemia and the often atypical presentations found.
authors.affiliation: Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Helen Emily
authors.identifier: http://orcid.org/0000-0002-1545-692X
authors.initials: HE
authors.lastname: Chase
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: Joe Hwong
authors.initials: JH
authors.lastname: Pang
authors.affiliation: Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Anish Pradip
authors.initials: AP
authors.lastname: Sanghrajka
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis; D003937:Diagnosis, Differential; D005264:Femoral Fractures / Q000209:etiology*; D015775:Fractures, Stress / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis