Pathologic fracture that may represent a neoplasm.

Pathologic fracture that may represent a neoplasm.

Question 4

An 18-month-old African American girl is brought to your office because she has been crying and stopped walking today. She will crawl, however. Her mom denies any injury to the child. On examination, she is crying but consolable in her mother’s arms. She has bruising and swelling just proximal to the left ankle. An x-ray reveals a spiral fracture of the tibia. At this time, you advise the mother that:

You are going to report this to child protective services as suspected abuse.
You are going to refer the child for a bone biopsy because this is a pathologic fracture that may represent a neoplasm.
This is a common fracture resulting from twisting on a planted foot.
You should draw blood to evaluate for sickle cell disease, which may cause infarction of the bone.

Question 5

Tracy, the mother of a 2-year-old, is concerned because her daughter walks on her toes all the time. What do you tell her?

“Toe walking is considered normal until age 3.”
“Don’t worry, she’ll outgrow it.”
“Toe walking is normal until she starts kindergarten.”
” We should do further testing now.”

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