Bilateral distal tibial stress fractures in a military recruit

Abstract

Stress fractures are common injuries in athletes and military recruits. They result from repetitive microtrauma, which over time exceeds the bone's intrinsic ability to repair itself. The site of occurrence is most commonly the weight-bearing lower limb. Such injuries are easily missed as the history and clinical signs are often not consistent with an acute injury and therefore may not warrant an x-ray on first presentation to the emergency department or primary care. Even when plain radiographs are taken, the fractures may not be initially evident and in the presence of a high index of clinical suspicion, further investigations may be necessary. We present the case of a military recruit who developed bilateral distal tibial stress fractures early on in his training.

Segmental Stress Fracture of Tibia in Recreational Running: A Case Report

“…In the literature investigated, we found cases of bilateral stress fractures in the lower limbs 11 . However, we did not find cases of segmental fractures of the tibia, which proves the rarity of the case reported here.…”

Bilateral distal tibial stress fractures in a healthy field-hockey goalkeeper

“…Reports of bilateral distal tibial stress fractures are even less common 10–13. Associated aetiological factors include military exercises,10 chronic liver disease,11 prolonged heavy lifting on stairs12 and heavy smoking 13. Our patient did not report any of these risk factors, and we could find no reports in the literature regarding distal tibial stress fractures related to field hockey or goalkeeping.…”

Bilateral Distal Tibial Stress Fracture in a Triathlete

“…We can distinguish from fatigue stress fractures (abnormal load on normal bone) and insufficiency stress fractures (normal load on abnormal or osteopenic bone) (8). It is important to have a high level of suspicion of a stress fracture when we check on a patient who presents with bone pain after an intense physical training or after new/unusual activity (9,13). Early X-rays of a stress injury can be initially completely normal therefore more specific and sensitive diagnostics must be performed.…”