Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature

Avascular Necrosis of Proximal Tibia Associated with Pathological Fracture - A Rare Entity - A Case Report

Introduction

Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, metaphyseal and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in literature. Proximal third tibial shaft pathological fracture due to avascular necrosis (AVN) is an extremely rare occurrence.

Case Report

A 56-year-old lady presented with complaints of pain and inability to weight bear over the right leg following an alleged history of trivial trauma while doing household activities. The radiograph showed a transverse fracture at the junction of the proximal third and middle third of the shaft of the tibia. In view of the suspicion of pathological fracture, magnetic resonance imaging of the right leg was done which showed features of AVN. A core biopsy of the lesion was done to rule out tumors considering the risk of malignant transformation. Fixation of fracture was done with intramedullary interlocking nailing of the tibia. The 6-month post-operative follow-up clinical, pathological, and radiological outcome showed complete healing of the fracture. The stabilization of fracture alone without augmentation led to fracture healing.

Conclusion

AVN need not always occur in precarious areas such as the head of the femur, proximal radius, and distal fibula. Rarely, AVN of diaphyseal bone can lead to pathological fracture as illustrated in this case report. Fractures can heal following fixation, but the patient has to be followed up for the rare possibility of malignant transformation.

Joint-preserving surgery for idiopathic bilateral osteonecrosis of the distal tibia: A case report

Introduction

Osteonecrosis (ON) is a serious pathological condition that can affect weight-bearing areas of the lower limbs, including the distal tibia. Although trauma is a common cause of ON, the condition has multiple possible etiologies. ON has been associated with a range of factors, including trauma, medication use, alcoholism, and vascular disease. Interruption of blood flow to a particular bone region is the first step in the pathophysiology of ON. Conservative management is typically indicated in the early stages of ON, but joint-preserving procedures may be necessary in cases where conservative treatment fails.

Case Report

This article presents a case of bilateral ON of the distal tibia in a 38-year-old female patient without a history of trauma or identifiable risk factors. The patient was initially managed conservatively but ultimately underwent joint-preserving surgery due to treatment failure.

Conclusion

Joint-preserving procedures should be considered in cases of early-stage distal tibia ON that do not respond to conservative management to prevent joint collapse. This case highlights the importance of considering ON as a possible diagnosis even in the absence of identifiable risk factors or trauma.

Osteonecrosis of the Intermediate Cuneiform: A Case Report

Osteonecrosis is a disease that rarely affects the bones of the foot. When present, it is more common in the talus and in the navicular. Cases of osteonecrosis of the intermediate cuneiform are extremely rare, and after a thorough bibliographic review, we found only five reports in the literature, all of them in pediatric patients. Below, we present the case of an adult patient with osteonecrosis of the intermediate cuneiform that was resistant to conservative treatment. Thus, we proposed a surgical approach with good results. Level of Evidence V; Therapeutic Studies; Expert Opinion .

Osteonecrosis of the distal tibia in systemic lupus erythematosus: A rare case report

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Despite advances in the diagnosis and treatment of systemic lupus erythematosus (SLE), symptomatic osteonecrosis continues to be a significant comorbidity.

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Strategies to detect and manage early stages of osteonecrosis is necessary to prevent progression of this serious complication.

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We present a case of 23-year-old female diagnosed with osteonecrosis of the distal tibia and history of SLE.

Introduction

Osteonecrosis (ON) is characterized by cellular death of bone components due to interruption of blood supply that leads to bone ischemia and potential joint destruction. There are multiple risk factors and medical condition associated with ON, including systemic lupus erythematosus (SLE). The most common sites of ON are the femoral head, distal femur, proximal humerus, talus and lumbar spine. Very few cases of nontraumatic ON in distal tibia have been reported in the literature.

Case Illustration

We present a case of 23-year-old female diagnosed with osteonecrosis of distal tibia and history of SLE. The patient also had history of avascular necrosis of right hip and underwent right total hip arthroplasty. We treated the patients with conservative treatment for intial management.

Discussion

The risk of ON in SLE patients is likely due to the results of both the SLE itself and use of corticosteroids. Systemic inflammation in SLE reduces the development of osteoblasts, increases osteoclast maturation and activity and increases protohrombotic agents that can lead to rapid bone loss. Corticosteroids are the most consistent risk factor associated with the development of ON in SLE. Conservative medical management is effective in the early stages of the disease before bone collapse.

Conclusion

Despite advances in the diagnosis and treatment of SLE, symptomatic ON continues to be a significant comorbidity. Strategies to detect and manage early stage ON is necessary to prevent the progression of this serious complication.

Avascular Necrosis of the Tibial Plafond Following Rotational Ankle Fractures

Avascular necrosis (AVN) following rotational ankle fractures is most commonly described in the talus; however, it can also occur in the tibial plafond. These sequelae of ankle fractures are rarely described in the literature. Diagnosis of AVN is best confirmed with MRI of the involved extremity. Treatment options range from conservative treatments such as observation and limited weight-bearing to surgical management including percutaneous drilling, ankle arthrodesis, and total ankle arthroplasty. More research is needed to further identify patients at high risk for developing these sequelae of ankle fractures and to aid in the treatment and surgical decision-making process.