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<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.1 20151215//EN" "JATS-journalpublishing1.dtd">
<article xml:lang="KO" article-type="case-report">

<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Korean Orthop Assoc</journal-id>
<journal-id journal-id-type="publisher-id">JKOA</journal-id>
<journal-title-group>
<journal-title>Journal of the Korean Orthopaedic Association</journal-title>
</journal-title-group>
<issn pub-type="ppub">1226-2102</issn>
<issn pub-type="epub">2005-8918</issn>
<publisher>
<publisher-name>The Korean Orthopaedic Association</publisher-name>
</publisher>
</journal-meta>

<article-meta>
<article-id pub-id-type="doi">10.4055/jkoa.2016.51.5.437</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Proximal Tibia Stress Fracture Caused by Primary Degenerative Knee Osteoarthritis with Varus Deformity</article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author" corresp="yes">
<name>
<surname>Lee</surname>
<given-names>Joong-Myung</given-names>
</name>
<degrees>M.D.</degrees>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kwon</surname>
<given-names>Young-Woo</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

</contrib-group>

<aff id="A1">Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.</aff>

<author-notes>
<corresp>Correspondence to: Joong-Myung Lee, M.D., Ph.D. Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. TEL: +82-31-780-5289 FAX: +82-31-708-3578, <email>drjmlee@naver.com</email></corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>26</day>
<month>10</month>
<year>2016</year>
</pub-date>
<volume>51</volume>
<issue>5</issue>
<fpage>437</fpage>
<lpage>442</lpage>

<history>
<date date-type="received">
<day>13</day>
<month>11</month>
<year>2015</year>
</date>
<date date-type="rev-recd">
<day>14</day>
<month>03</month>
<year>2016</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>03</month>
<year>2016</year>
</date>
</history>

<permissions>
<copyright-statement>Copyright &#x00A9; 2016 by The Korean Orthopaedic Association</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>

<abstract>
<p>Stress fractures of the tibia are relatively common in military and young people. However, stress fracture of the proximal tibia is rare in elderly patients, but has been reported in association with osteoporosis, Paget disease, rheumatoid arthritis, pyrophosphate arthropathy, and knee deformities. We experienced a 65-year-old patient who did not have a chronic disease, with a stress fracture with primary degenerative knee osteoarthritis with varus deformity, which occurred at the proximal tibia, and we report on this unusual case with a literature review.</p>
</abstract>

<kwd-group>
<kwd>stress fractures</kwd>
<kwd>proximal tibia</kwd>
<kwd>osteoarthritis</kwd>
<kwd>varus deformity</kwd>
</kwd-group>

</article-meta>
</front>

<back>

<fn-group>

<fn fn-type="conflict">
<label>CONFLICTS OF INTEREST</label>
  <p>The authors have nothing to disclose.</p>
</fn>
</fn-group>

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<floats-group>

<fig position="float" id="F1">
<label>Figure 1</label>
<caption>
  <title>Proximal tibial fracture is missed on the initial radiologic evaluation in other hospital because plain radiographs do not include enough of the fracture site.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g001"></graphic>
</fig>

<fig position="float" id="F2">
<label>Figure 2</label>
<caption>
  <title>Orthoradiogram shows varus knee alignment with degenerative medial compartmental osteoarthritis of the knee joints at left (arrow).</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g002"></graphic>
</fig>

<fig position="float" id="F3">
<label>Figure 3</label>
<caption>
  <title>On initial radiographs, knee anteroposterior (A; arrow) and knee lateral (B; arrow), tibial stress fracture was apparent. An intracortical fracture was observed at the medial aspect of the proximal tibia with callus formation, suggesting a stress fracture at left.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g003"></graphic>
</fig>

<fig position="float" id="F4">
<label>Figure 4</label>
<caption>
  <title>On bone scan (A) and (B), intense focal radioactive uptake in the left proximal tibial shaft, suggesting a fracture. Focally increased radioactive uptake in the medial compartment of the left knee suggests osteoarthritis.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g004"></graphic>
</fig>

<fig position="float" id="F5">
<label>Figure 5</label>
<caption>
  <title>Knee anteroposterior (A) and knee lateral (B) show that total knee arthroplasty with a long tibial stem bridging the fracture site was performed.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g005"></graphic>
</fig>

<fig position="float" id="F6">
<label>Figure 6</label>
<caption>
  <title>Radiographs obtained 6 months later show a nearly healed tibial stress fracture. After left knee replacement the alignment is reasonable.</title>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="jkoa-51-437-g006"></graphic>
</fig>

</floats-group>

</article>