J Korean Orthop Assoc.  2016 Oct;51(5):437-442. 10.4055/jkoa.2016.51.5.437.

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

• Lee JM
• Kwon YW

• KMID: 2355510
• DOI: http://doi.org/10.4055/jkoa.2016.51.5.437

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.

Keyword

stress fractures; proximal tibia; osteoarthritis; varus deformity

MeSH Terms

Aged
Arthritis, Rheumatoid
Chronic Disease
Congenital Abnormalities*
Fractures, Stress*
Humans
Knee*
Military Personnel
Osteoarthritis
Osteoarthritis, Knee*
Osteoporosis
Tibia*

Figure

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  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.

Reference

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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.

5. Ross DJ, Dieppe PA, Watt I, Newman JH. Tibial stress fracture in pyrophosphate arthropathy. J Bone Joint Surg Br. 1983; 65:474–477.

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.