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Journal of Bone and Joint Surgery, 1939;21:891-901.
© 1939 by The Journal of Bone and Joint Surgery, Inc

PSEUDOFRACTURE OF THE TIBIA

SUMNER M. ROBERTS M.D. and EDWARD C. VOGT M.D.

Pseudofracture of the tibia is a clinical entity involving the upper third of the tibial shaft in children between the ages of four and sixteen. At one stage of the disease the roentgenographic appearance may simulate a fracture, but acute trauma, nevertheless, is not an etiological factor.

The exact nature of the disease is not known. There is a possibility that it may be due to a chronic infectious process. The pathological reports on two of the cases in which biopsies were done suggested this, as did the slight fever and leukocytosis present in three of the cases. Ollonqvist, in Finland, has reported a series of cases which simulate this condition. His cases, however, occurred in young army recruits, and in each case the lesion was in the middle third of the tibia instead of in the upper third. March foot is another condition that gives a similar roentgenographic appearance except for the location. The etiology of this latter condition, as well as that of the disease described by Ollonqvist, remains unknown. Other authors have commented on what were probably lesions akin to pseudofracture. Several German writers speak of an "Umbauzone" and note its occurrence in other bones besides the tibia. Reischauer calls them "wear-and-tear" fractures, due to active use of the limb, particularly in soldiers. We hope that study of the circulation in growing children may give some clue, as the roentgenograms suggest that the pseudofracture line may be influenced by the course of a nutrient artery.


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