An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia

Atraumatic Isolated Stress Fracture of the Distal Tibial Metaphysis in a Pre-menopausal Patient: A Case Report

Stress fractures are partial or complete bone fractures usually occurring in the weight-bearing bones resulting from repeated cycles of submaximal stress and bone remodeling. When the tibia is involved, it usually affects the proximal or middle third part of the bone. This pathology is most often seen in athletes or related to traumatic activities. This case describes a healthy, pre-menopausal, non-athlete woman presenting with a distal tibial atraumatic stress fracture. Diagnosis is usually confirmed by a CT scan or MRI since radiographs could often show no abnormalities. Treatment of such fractures is conservative in the majority of cases and when present, predisposing or causative factors should also be investigated and assessed.

Delayed Diagnosis of a Tibial Stress Fracture Associated with Glucocorticoid and Methotrexate Therapy in a Patient with Rheumatoid Arthritis: A Case Report

The risk of stress fractures is associated with rheumatoid arthritis (RA), which can aggravate bone loss. We report the case of a patient who was on long-term medication for RA presenting with lower extremity pain on the left and swelling without trauma. Magnetic resonance imaging and plain radiographs at the previous hospital showed no signs of fracture, but radiographs performed later, revealed a stress fracture of the left distal tibia. The stress fracture may have occurred due to multiple reasons such as long-term use of methotrexate and glucocorticoids, active RA, postmenopausal state, and immobility. Suspicion of a stress fracture should not be ruled out especially in RA patients with persistent pain, even if the radiographical findings are normal. Additional imaging and follow-ups are essential. The patient’s pain was relieved with Korean medicine treatments, which suggests their potential application for stress fractures in RA patients.

A repetitive spontaneous distal tibial insufficiency fracture: an unusual case report

Stress fractures typically occur, when cyclic loading to the healthy bone exceeds the normal carrying range capacity. These fractures are most commonly seen in athletes and military recruits who are engaged with intensive physical exercise in their daily lives. Stress fractures can also occur in a variety of conditions, in which the mineral content or the elasticity of bone is abnormal and defined as an insufficiency fracture. The tibia is the most frequent location for stress fractures, while bilateral tibial fractures are extremely rare. Herein, we report a repetitive spontaneous distal tibial insufficiency fracture in the right and left distal tibia and discuss predisposing factors, diagnosis, and treatment in the light of the current literature.