**10. Fractures of the tibia**

These fractures are also extremely rare and are found in combination with fractures of the femur or humerus. Underlying bone fragility is suspected and investigations for possible OI or rickets must be performed. Neonate abuse syndrome must also be verified. We have followed a neonate that sustained fractures of the femur and tibia during birth after having a normal uncomplicated vaginal delivery. At the age of 2 years there is only short stature, without underlying metabolic disease (**Figures 25**–**27**).

#### **Figure 23.**

*Hyperostosis of the forearm (Caffey disease). Initial X-ray with periosteal reaction and plastic deformation of the radius and ulna on the right side, while the left forearm is normal. The radiological appearance at 1 year, showing widening of the forearm bones.*

#### **Figure 24.**

*Hyperostosis of the forearm (Caffey disease). Initial X-ray with periosteal reaction and plastic deformation of the radius and ulna on the right side, while the left forearm is normal. The radiological appearance at 1 year, showing widening of the forearm bones.*

#### **Figure 25.**

*Multiple fractures of femur (right with callus formation, spiral left femoral fracture and tibia left). X-rays at birth and at 3 months. At the age of 2 yrs, there are no more fractures reported. The toddler is low height.*

Metaphyseal greenstick type of fracture may be found as a result of vigorous handling of the leg of the neonate. They are differentiated from cases of fibrocartilaginous bowing that are usually found during the standing period of the infant. Constriction band syndrome with tibia and fibula fracture has also been reported. Congenital pseudoarthrosis of the tibia or fibula is diagnosed rarely in the neonatal period as part of the neurofibromatosis, presenting with anteromedial bowing. Congenital posterolateral bowing of the leg is a congenital benign deformity that is not correlated with a fracture [29, 66, 71–73].

#### **Figure 26.**

*Multiple fractures of femur (right with callus formation, spiral left femoral fracture and tibia left). X-rays at birth and at 3 months. At the age of 2 yrs, there are no more fractures reported. The toddler is low height.*

#### **Figure 27.**

*Multiple fractures of femur (right with callus formation, spiral left femoral fracture and tibia left). X-rays at birth and at 3 months. At the age of 2 yrs, there are no more fractures reported. The toddler is low height.*
