Bilateral Synchronous Stress Fracture of the Tibia in a Young Female Basketball Player

Simultaneous bilateral posteromedial tibial epiphysis stress fractures in a healthy young man: A case report

We present a compelling case of simultaneous, bilateral tibial stress fractures occurring in a unique epiphyseal and posterior location, with unclear aetiology. An overweight, Caucasian male in his late 20s developed synchronous bilateral medial knee pain following an intense 10-day training regimen. His radiographies were normal, but MRI revealed almost identical bilateral stress fracture lines in the posteromedial tibial epiphyses. Bone mineral densitometry and a full metabolic and hormonal panel were performed to further investigate potential underlying metabolic bone disease. He was found to have normal bone mineral densitometry and low Vitamin D serum values. Symptomatology greatly improved with activity modification. There were no further complaints and complications at 12 months' follow-up. Diagnosis can be challenging and the treating physician should be acquainted with the basic science of stress fractures and main discriminating clinical, biochemical and radiological characteristics from insufficiency fractures, to avoid pitfalls in treatment decision.

Bilateral Simultaneous Proximal Tibial Insufficiency Fractures in a Patient Suffering From Psoriatic Arthritis

Bilateral synchronous proximal tibia insufficiency fractures are rarely reported. We present a case of simultaneous proximal tibia bilateral insufficiency fractures in a 51-year-old female patient with underlying psoriatic arthritis, who was on chronic steroid medication. She reported sudden onset of bilateral knee pain after intense workout one week ago. Initial clinical and X-ray evaluation did not reveal significant pathology. Four weeks later, due to persistent pain in the absence of significant radiographic findings during follow-up, the patient was referred for MRI, which revealed fractures of both proximal tibias. A "mixed" treatment protocol was applied. In particular, this protocol included combination of rest and intermittent removable knee ranger braces immobilization with weight-bearing when applied. The patient went on to make a full recovery. Chronic inflammatory disorders accompanied by suspicious clinical manifestations should be thoroughly inspected. Diagnostic and treatment protocols should be further discussed and implemented.