Proximal tibial stress fracture

Case contributed by Dr Dai Roberts

Presentation

Ongoing knee and proximal leg pain, no history of trauma. Obese.

Patient Data

Age: 40 years
Gender: Female
X-ray

Minimally impacted transverse oblique fracture through the medial tibial diametaphysis, with cortical interruption and a faint sclerotic line continuing to reach the lateral cortex.  Moderate medial compartment osteoarthritis, with mild changes within the patellofemoral joint, both advanced for age.

CT confirms the minimally impacted fracture of the medial tibial diametaphysis, with extension across the posterior tibial cortex.  The zigzag fracture line and lack of a single traumatic event make a stress fracture more likely.  

Case Discussion

Stress fractures occur when there is abnormal stress on normal bone.  A correlating history can help, which will often state a sudden increase in training load or an insidious onset of symptoms.  The patient's body habitus will have contributed to the abnormal load through the tibia.

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Case information

rID: 76786
Published: 22nd Jul 2020
Last edited: 25th Jul 2020
Inclusion in quiz mode: Included

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