Periosteal Elevation

These are usually Salter-Harris Type I or II fractures caused by a supination-inversion injury. They may not be evident on plain X-ray and are often incorrectiy diagnosed as an ankle sprain. Ultrasound is very accurate in detecting the cortical discontinuity, periosteal elevation and subperiosteal fluid which accompanies these fractures (Simanovsky et aL 2005). Where these injuries occur in isolation they should be managed in a below-knee walking cast for 3 to 4 weeks. Significantly displaced distal fibular fractures associated with Salter-Harris Type III or IV injuries usually reduce with re-... 

Conclusions The mechanisms by which chronic voriconazole treatment predisposes to periostitis seem to involve highly elevated fluorine levels, although other coinciding factors are most likely affecting as well. Plasma fluorine levels are usually elevated after 6 months of voriconazole administration but improvement of symptoms after voriconazole discontinuation is fast. 

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