Tibial plateau insufficiency fracture

Case contributed by Dr Bruno Di Muzio

Presentation

Acute pain in the right knee. Normal radiographs (not shown).

Patient Data

Age: 78-year-old
Gender: Female

Right knee MRI

Modality: MRI

Changes of osteoarthritis are more marked in the lateral compartment with there is very little normal remaining articular cartilage but are also present in the medial and patellofemoral compartments.

A pattern of bone marrow oedema in the tibial plateau particularly medially is associated with a horizontal fracture line consistent with an insufficiency fracture.

There is very little remaining lateral meniscus. Complex degenerative tear of the posterior horn and body of the medial meniscus.

The ACL and PCL are within normal limits. Collateral ligaments are unremarkable.

There is a small Baker's cyst emerging between the semimembranosus tendon and the medial head of the gastrocnemius. Mild tendinopathy of the popliteus tendon.Quadriceps tendon, patella, and patellar tendon are unremarkable.

Small joint effusion.

Conclusion: Tricompartmental osteoarthritis, worse on the lateral compartment. Insufficiency fracture right-sided tibial plateau.

Modality: Annotated image

A pattern of bone marrow oedema (arrows) in the tibial plateau particularly medially is associated with a horizontal fracture line (circular dashed line) consistent with an insufficiency fracture.

Case Discussion

Insufficiency fractures are a type of stress fracture, which are the result of normal stresses on abnormal bone. This diagnosis was achieved based on the clinical data and imaging appearances.

These fractures are usually not identified on conventional radiographs. Radionuclide bone scan, and especially MRI are the modalities of choice when assessing this condition.

In this case, the MRI also demonstrated the tri-compartmental diffuse and advanced osteoarthritis. 

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Case Information

rID: 44938
Case created: 9th May 2016
Last edited: 9th May 2016
Tag: rmh
Inclusion in quiz mode: Included

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