Distal Tibial Stress Fracture Secondary to Severe Osteoarthritis Knee

Raviraj Adala, Surendranath Shetty, Ashish Anand, Rajendran Ravidnran

Department of Orthopedic Surgery, Fortis Hospitals Ltd., Bangalore, India.

DOI: 10.4236/ss.2013.44047                

Abstract

Stress fractures of the tibia are commonly seen in young athletes or military recruits due to repetitive micro trauma. These are rare in elderly patients. Osteoarthritis knee with varus deformity leading to stress fracture is rare but has been reported in literature. Stress fracture in osteoarthritis more commonly occurs in upper third tibia. We report a patient who had stress fractures of distal tibial shaft secondary to advanced osteoarthritis of knee with varus deformity.

Keywords

Fracture; Stress; Fractures; Tibia; Osteoarthritis; Knee; Tibia

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. Milgrom, M. Giladi, M. Stein, H. Kashtan, J. Margulies, R. Chisin, R. Steinberg, A. Swiss and Z. Aharonson, “Medial Tibial Pain: A Prospective Study of Its Cause among Military Recruits,” Clinical Orthopaedics, Vol. 213, 1986, pp. 167-171.
[2]	M. Devas, “Stress Fractures,” Churchill Livingstone, Edinburgh, 1975.
[3]	M. Giladi, Z. Ahronson, M. Stein, Y. L. Danon and C. Milgram, “Unusual Distribution and Onset of Stress Fractures in Soldiers,” Clinical Orthopaedics, Vol. 192, No. , 1985, pp. 142-145.
[4]	D. J. Ross, P. A. Dieppe, I. Watt and J. H. Newman, “Tibial Stress Fracture in Pyrophosphate Arthropathy,” Journal of Bone & Joint Surgery (British), Vol. 65, No. 4, 1983, pp. 474-477.
[5]	M. T. Reynolds, “Stress Fractures of the Tibia in the Elderly Associated with Knee Deformity,” Journal of the Royal Society of Medicine, Vol. 65, No. 4, 1972, pp. 377-380.
[6]	F. Wheeldon, “Spontaneous Fractures in the Shin in the Presence of Knee Deformities,” Journal of the Royal Society of Medicine, Vol. 54, 1961, p. 1108.
[7]	A. Young, P. Kinsella and P. Boland, “Stress Fractures of the Lower Limb in Patients with Rheumatoid Arthritis,” Journal of Bone & Joint Surgery (British), Vol. 63-B, No. 2, 1981, pp. 239-243.
[8]	K. Satku, V. P. Kumar and R. W. H. Pho, “Stress Fractures of the Tibia in Osteoarthritis of the Knee,” Journal of Bone & Joint Surgery (British), Vol. 69, No. 2, 1987, pp. 309-311.
[9]	E. D. Nabors, T. E. Kremchek and D. W. Burke, “Stress Fracture of the Proximal Tibia Associated with Severe Osteoarthritis,” American Journal of Knee Surgery, Vol. 8, 1995, pp. 141-143.
[10]	I. K. Tey, K. W. Chong and I. Singh, “Stress Fracture of the Distal Tibia Secondary to Severe Knee Osteoarthritis: A Case Report,” Journal of Orthopaedic Surgery, Vol. 14, No. 2, 2006, pp. 212-215.
[11]	J. Kopacz, E. Warda and T. Mazurkiewicz, “Stress Fractures of the Tibia in Elderly Women [in Polish],” Chirurgia Narzadow Ruchu i Ortopedia Polska, Vol. 67, No. 5, 2002, pp. 515-520.
[12]	M. H. Sy, S. Diouf, A. Ndoye and M. Coume, “A New Case of Tibial Stress Fracture as a Complication of Knee Osteoarthritis [in French],” Revue de Chirurgie Orthopedique et Reparatrice de l’Appareil Moteur, Vol. 81, No. 5, 1995, pp. 445-448.
[13]	B. G. Seral, D. Palanca and F. Seral, “Stress Fracture of the Proximal Tibia Associated with Severe Osteoarthritis of the Knee. Case Report,” American Journal of Knee Surgery, Vol. 10, No. 4, 1997, pp. 228-231.
[14]	M. R. Sawant, S. P. Bendall, T. G. Kavanagh and N. D. Citron, “Nonunion of Tibial Stress Fractures in Patients with Deformed Arthritic Knees. Treatment Using Modular Total Knee Arthroplasty,” Journal of Bone & Joint Surgery (British), Vol. 81, No. 4, 1999, pp. 663-666. doi:10.1302/0301-620X.81B4.9091
[15]	W. M. Chen, C. K. Huang, T. H. Chen, C. C. Chiang and W. H. Lo, “Bilateral Proximal Tibial Stress Fractures in Osteoarthritic Knee Treated with Simultaneous Corrective Osteotomy and Internal Fixation,” Journal of the Chinese Medical Association, Vol. 67, No. 1, 2004, pp. 48-50.
[16]	M. Haspl, M. Jelic and M. Pecina, “Arthroplasty in Treating Knee Osteoarthritis and Proximal Tibia Stress Fracture,” Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, Vol. 70, No. 5, 2003, pp. 303-305.
[17]	M. Alms, “Fracture Mechanics,” Journal of Bone & Joint Surgery (British), Vol. 43-B, 1961, pp. 162-166.