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May 9, 1977

Stress Fractures in Children

JAMA. 1977;237(19):2038. doi:10.1001/jama.1977.03270460024014

To the Editor.—  Dr John A. Smith, in "Periosteal Elevation in a 2 1/2-Year-Old Child" (236:2323, 1976), makes the case for sequential roentgenographic studies in cases of stress fracture, and, indeed, in other cases of subtle injury to bone. It is regrettable that the discussion leaves one with the impression that this is the only course to follow in such cases.With the introduction of technetium-labeled compounds in bone imaging, the use of radionuclides in evaluating benign disorders of bone has become acceptable. Exposure to ionizing radiation is low enough to allow administering these compounds even to children. We are now free of the onerous restrictions that surrounded the use of radioactive strontium and the like.Bell and co-workers1 include evaluation of fractures not disclosed by x-ray films among the indications for bone scanning in children. Forhan and Panolil,2 Forhan,3 and Marty and coworkers4 all regard radionuclide studies