Bilateral tibial stress fractures: a case report

Abstract

A stress fracture can be defined as a fracture of a bone caused by repeated (rather than sudden) mechanical stress. They have been reported in almost all bones of the body, with the lower extremity weight bearing bones, especially the tibia, tarsals and metatarsals, being affected most often. These injuries have a broad spectrum of severity and prognosis. Although the pathology of this injury is understood, the aetiology is less agreed upon. This can make it difficult for clinicians to diagnose and treat this common injury. Stress fractures of the proximal tibiae are common in elderly patients with osteoarthritis, and they are also reported in children. Here, we report an unusual case of an otherwise fit, young, adult male who presented with bilateral insufficiency stress fractures occurring simultaneously in both proximal tibiae. Stress fractures should be a differential diagnosis in any young, fit adult who presents with spontaneous knee pain.

Bilateral Simultaneous Proximal Tibial Insufficiency Fractures in a Patient Suffering From Psoriatic Arthritis

“…Having this in mind during the initial examination, we recommended non-weight-bearing measures and follow-up in a month. Obviously, sensitivity depends on time elapsed between initial injury and X-ray depiction [14]. Yet, during follow-up, no significant radiographic pathology was detected.…”

“…First of all, MRI has the benefit to evaluate both skeletal structures and soft tissues in the knee [7]. Secondly, it is supported in more recent literature for accurate diagnosis of the common transverse or oblique tibial stress fractures [14].…”

“…However, stress fractures are well known for appearance without obvious breakage or lucency lines, especially in early stages and around the knee [4,7,9,14]. In particular, diagnostic sensitivity is less than 15% in initial X-rays; moreover, 50% of stress fractures are missed at first follow-up [9,14]. Having this in mind during the initial examination, we recommended non-weight-bearing measures and follow-up in a month.…”

“…Further imaging investigation was decided. Nowadays, there is a variety of imaging techniques that can be selected, such as bone scans, CT scans, or MRI scans [4,7,8,14]. MRI was selected for two reasons in our case.…”

Simultaneous, Asymmetrical, Comminuted and Bilateral Ballistic Fractures by Multiple Gunshot Wounds and a Review of Its Literature: A Case Report in Chad

“…These can be simultaneous, symmetrical, asymmetrical, open or closed [3] [4] [5] [6] [7]. These are quite rare and are usually observed in young adults.…”