Differential Diagnosis for Distal Tibial Metaphysis Injury with Cortical Buckling

• Single most likely diagnosis:
  • Torus fracture: This is a type of fracture that occurs when the cortex of the bone buckles due to compression. The distal tibial metaphysis is a common location for this type of injury, especially in children. The cortical buckling along the medial aspect is consistent with a torus fracture.
• Other Likely diagnoses:
  • Greenstick fracture: This type of fracture occurs when one side of the bone bends and partially breaks, while the other side remains intact. The distal tibial metaphysis is a possible location for a greenstick fracture, and cortical buckling could be seen along the medial aspect.
  • Compression fracture: Although less common in the distal tibia, a compression fracture could result in cortical buckling, especially if the force of the injury was directed axially.
• Do Not Miss diagnoses:
  • Pathologic fracture: Although less likely, a pathologic fracture due to an underlying bone lesion (e.g., osteosarcoma, osteomyelitis) could present with cortical buckling. Missing this diagnosis could have significant consequences.
  • Stress fracture: A stress fracture could occur in the distal tibial metaphysis, especially in athletes or individuals with repetitive stress on the bone. While less likely to present with cortical buckling, it is a diagnosis that should not be missed due to its potential for complications if not properly treated.
• Rare diagnoses:
  • Osteogenesis imperfecta: This genetic disorder affects bone strength and could lead to fractures with minimal trauma, including cortical buckling in the distal tibial metaphysis.
  • Fibrous dysplasia: A rare condition where normal bone is replaced with fibrous tissue, potentially leading to weakened bones that could fracture, including the distal tibia, with unusual patterns such as cortical buckling.