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Lee and Kwon: Proximal Tibia Stress Fracture Caused by Primary Degenerative Knee Osteoarthritis with Varus Deformity
Case Report

Journal of the Korean Orthopaedic Association 2016; 51(5): 437-442.

Published online: 26 October 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.5.437

Proximal Tibia Stress Fracture Caused by Primary Degenerative Knee Osteoarthritis with Varus Deformity

Joong-Myung Lee, M.D., Ph.D., Young-Woo Kwon, M.D.

Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

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, drjmlee@naver.com

Received 13 November 2015       Revised 14 March 2016       Accepted 23 March 2016

Copyright © 2016 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: stress fractures, proximal tibia, osteoarthritis, varus deformity

Figures and Tables

Figure 1

Proximal tibial fracture is missed on the initial radiologic evaluation in other hospital because plain radiographs do not include enough of the fracture site.

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Figure 2

Orthoradiogram shows varus knee alignment with degenerative medial compartmental osteoarthritis of the knee joints at left (arrow).

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Figure 3

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.

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Figure 4

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.

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Figure 5

Knee anteroposterior (A) and knee lateral (B) show that total knee arthroplasty with a long tibial stem bridging the fracture site was performed.

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Figure 6

Radiographs obtained 6 months later show a nearly healed tibial stress fracture. After left knee replacement the alignment is reasonable.

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Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Devas M. Stress fractures. Edinburgh: Churchill Livingstone;1975.
2. Resnick D, Guerra J Jr. Stress fractures associated with adjacent osteoarthritis. J Rheumatol. 1981; 8:161–164.
Grundy M. Fractures of the femur in paget's disease of bone. Their etiology and treatment. J Bone Joint Surg Br. 1970. 52:252–263.
4. Young A, Kinsella P, Boland P. Stress fractures of the lower limb in patients with rheumatoid arthritis. J Bone Joint Surg Br. 1981; 63:239–243.
crossref
5. Ross DJ, Dieppe PA, Watt I, Newman JH. Tibial stress fracture in pyrophosphate arthropathy. J Bone Joint Surg Br. 1983; 65:474–477.
crossref
6. Reynolds MT. Stress fractures of the tibia in the elderly associated with knee deformity. Proc R Soc Med. 1972; 65:377–380.
7. Kelly JM. Stress fractures in the tibia associated with knee deformities. J Ir Med Assoc. 1974; 67:97–99.
8. Sourlas I, Papachristou G, Pilichou A, Giannoudis PV, Efstathopoulos N, Nikolaou VS. Proximal tibial stress fractures associated with primary degenerative knee osteoarthritis. Am J Orthop (Belle Mead NJ). 2009; 38:120–124.
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