Acute leukemia of childhood may present with various clinical
manifestations that mimic orthopaedic conditions. The osseous radiographic
abnormalities of this disease, although well described in the literature,
are not pathognomonic, and certain changes may not be as frequent as was
previously thought. In a retrospective study, we reviewed the cases of 107
patients, less than eighteen years old, who had been seen at the Winnipeg
Children's Hospital. The mean follow-up was 4.6 years for the fifty-eight
patients who were still alive and 2.0 years for the forty-nine
non-survivors. In twenty-two (20.6 per cent) of the patients, the
presenting complaints were pain in the extremities, back pain,
osteomyelitis, septic arthritis, or fracture. The radiographic
abnormalities, which were present in forty-seven (43.9 per cent) of the
children at the time of diagnosis, were osteopenia, lytic lesions,
metaphyseal bands, periosteal new bone, and sclerotic lesions. Since the
initial symptoms of leukemia commonly involve the musculoskeletal system, a
high index of suspicion must be maintained by orthopaedic surgeons.