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A 2-year-old boy, who was previously well, was admitted for limping associated with left knee pain of 1 month duration. There was no history of witnessed trauma or significant infective symptoms. Systemic review was otherwise unremarkable. Prior to his onset of signs, he was able to cruise with support, and had some mild isolated speech delay. There was no significant family history of medical conditions. His main caregivers on weekdays were two sets of grandparents when his parents were working, while his parents took over his care on weekends. Physical examination was normal, except for tenderness of his left knee joint and his inability to weight-bear.
An X-ray of his left knee joint showed a healing fracture of the left distal femoral metaphysis with associated bony sclerosis at the fracture margins, as well as periosteal reaction in the distal femur. In addition, …
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.