Three stress fractures at different sites in the same tibia–a case report

Ariyoshi, Mamoru; Nagata, Kensei; Kubo, Manabu; Sato, Kengo; Inoue, Akio

doi:10.3109/17453679708996189

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…Until now, there has only been 1 article published by Aryoshi et al who described a similar case. 6 The precise pathogenesis for these spontaneous fractures is different whether we deal with fatigue fractures or insufficiency fractures. Fatigue fractures result from a variety of activities, and so the site of occurrence is activity-related.…”

Section: Discussionmentioning

confidence: 99%

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Multiple Tibial Insufficiency Fractures in the Same Tibia

Defoort¹,

Mertens

2011

Geriatr Orthop Surg Rehabil

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Stress fractures were first described by Briethaupt in 1855. Since then, there have been many discussions in the literature concerning stress fractures, which have been described in both weight-bearing and non-weight-bearing bones. Currently, the tibia is the most frequent location, but multiple stress fractures in the same tibia are rare. This paper presents an unusual case of a 60-year-old woman with multiple tibial stress fractures of spontaneous onset.Keywords stress fracture, tibia, multiple, aged population Case ReportA 60-year-old woman was seen and followed at our department for right leg pain. The medical history of this woman included multiple depression episodes, resection of a benign left breast cancer tumor, morbus Parkinson, thyroid dysfunction after intake of lithium, and rib fractures after a fall. Her medication chart mentioned an antidepressant (imipramine), analgetics (paracetamol and tramadol), her Parkinson medication (prolopa and levodopa), and a sleeping tablet (lormetazepam).Her initial symptoms of lower right leg pain with associated redness of the overlying skin were experienced since June 2005. She first consulted the department of neurology, where she was admitted for further investigation. An ultrasound was helpful to exclude deep-venous thrombosis. Radiographic images confirmed the absence of any osseous pathology. Empiric antibiotics (amoxicillin) for possible erysipelas were commenced, without any result. Evoked potentials as well as EMG were normal. Laboratory analyses showed slightly elevated LDH but normal CRP and sedimentation rates, normal calcium levels and alkaline phosphatise, and normal vitamin D and PTH levels. Kidney and liver functions were also within normal range. Discharge with NSAIDs and observation.Fourteen days after discharge, the patient was readmitted with immense pain, inability to walk, mild swelling of her lower leg, and redness. Ultrasound showed some edema in the lower leg, while radiography revealed slight periosteal reaction on the dorsal side of the distal tibial metaphysis (Figure 1). Magnetic resonance imaging (MRI) confirmed the edema of the distal half of the tibia with concomitant inflammation of the surrounding soft tissue (arrow). Additionally, the MRI showed a fracture line in the distal tibia (arrowhead; Figure 2). All the above-mentioned signs and findings were in favor of a stress fracture (insufficiency fracture); however, infection or any malignant pathology still had to be ruled out. To complete the technical investigation, a bone scan was performed. Hyperemia of the middle and distal tibia suggestive of osseous pathology was found, no evidence of malignancy, however indicative for stress fracture versus osteomyelitis (Figures 3 and 4). The latter was ruled out by a leucocyte scan and renewal of laboratory analysis, which were normal and comparative to previous results. The diagnosis of insufficiency fracture at multiple sites of the same tibia was determined, despite no evidence of trauma or raised activity level of any kind. Tr...

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Section: Discussionmentioning

confidence: 99%

“…Stress fractures of the midanterior cortex are much less frequent. 6 Multiple stress fractures in the same bone are an extremely rare condition. Until now, there has only been 1 article published by Aryoshi et al who described a similar case.…”

Section: Discussionmentioning

confidence: 99%

Multiple Tibial Insufficiency Fractures in the Same Tibia

Defoort¹,

Mertens

2011

Geriatr Orthop Surg Rehabil

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Major international sport profiles

Patel

Stier²,

Luckstead

2002

Pediatric Clinics of North America

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Martial Arts

Buschbacher

Shay

1999

Physical Medicine and Rehabilitation Clinics of North America

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The martial arts have a reputation for being a high-risk activity, but are generally practiced in a safe environment. This article presents the results of a survey which is used to calculate risk of injury per 1000 hours of practice. The injury rate compares favorably with other mainstream activities; in fact, the martial arts are generally considered safer than most. The most common injuries occur to the wrist, hand, finger, foot, knee, head, and thigh. Special issues of importance for prevention and treatment of these injuries are discussed.

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Three stress fractures at different sites in the same tibia–a case report

Cited by 4 publications

References 11 publications

Multiple Tibial Insufficiency Fractures in the Same Tibia

Multiple Tibial Insufficiency Fractures in the Same Tibia

Major international sport profiles

Martial Arts

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