An 18-year-old male of Somalian ethnic background presented to accident and emergency with severe pain and swelling in his right knee. He had been playing football and described jumping and landing awkwardly on his right side. The patient described a mild but constant right knee pain over the last few years which exacerbated with strenuous activity. He also described similar left sided knee symptoms but had been reassured by his GP that the diagnosis was likely to be growing pains. He had no other past medical history and was a recreational footballer. On examination he had right-sided suprapatellar swelling with moderate effusion of the knee, was neurovascularly intact distally in the limb, had soft compartments and no evidence of an open injury.Bilateral radiographs were performed at presentation with Figure 1 A and B demonstrating an oblique supracondylar fracture of the right femur with evidence of sclerotic fracture edges and Figure 1 C showing a left distal femur indicating evidence of an oblique lucency in the supracondylar region associated with circumferential cortical thickening but no acute cortical break evident.Due to the acute right sided fracture, the patient was admitted and underwent a right retrograde femoral intramedullary nailing to stabilise the injury (Figure 2). A diagnosis of bilateral femoral stress fractures was made by exclusion of a pathological fracture. Pathological fracture was ruled out by clinical examination and history, sending specimens for analysis via histopathology and microscopy showing no evidence of infection or neoplasia and via imaging as described above. ABSTRACTBilateral supracondylar stress fractures of the femur in adolescents is a rare presentation. Due to the uncommon and non-specific presentation there is a high risk of misdiagnosis and thus detrimental complications. We report a case of bilateral supracondylar femur stress fractures in an 18 year old male of Somalian ethnic background who presented to our institution with a right oblique supracondylar fracture of the femur with evidence of sclerotic fracture edges. The patient was found to have symmetrical bilateral stress fractures of the femur which were missed in primary care and as a result of this weakening it ultimately lead to a fracture. Although stress fractures are most commonly seen in the osteoporotic population, other factors include: exercise type, anatomical and hormonal variables. Our case report highlights predisposition to stress fractures and the importance of heightened clinical suspicion when faced with adolescents presenting with chronic musculoskeletal pain.