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Proximal Tibial Stress Fracture Associated with Mild Osteoarthritis of the Knee: Case Report

Marko Ćurković orcid id orcid.org/0000-0002-4855-2133 ; University Department of Rheumatology and Rehabilitation, University Hospital Center, Zagreb, Croatia
Kristina Kovač ; University Department of Rheumatology and Rehabilitation, University Hospital Center, Zagreb, Croatia
Božidar Ćurković ; University Department of Rheumatology and Rehabilitation, University Hospital Center, Zagreb, Croatia
Đurđa Babić-Naglić ; University Department of Rheumatology and Rehabilitation, University Hospital Center, Zagreb, Croatia
Kristina Potočki ; University Department of Radiology, University Hospital Center, Zagreb, Croatia


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Abstract

Stress fractures are considered as multifactorial overuse injuries occurring in 0.3%-0.8% of patients suffering from rheumatic diseases, with rheumatoid arthritis being the most common underlying condition. Stress fractures can be classified according to the condition of the bone affected as: 1) fatigue stress fractures occurring when normal bone is exposed to repeated abnormal stresses; and 2) insufficiency stress fractures that occur when normal stress is applied to bone weakened by an underlying condition. Stress fractures are rarely associated with severe forms of knee osteoarthritis, accompanied with malalignment and obesity. We present a patient with a proximal tibial stress fracture associated with mild knee osteoarthritis without associated malalignment or obesity. Stress fracture should be considered when a patient with osteoarthritis presents with sudden deterioration, severe localized tenderness to palpation and localized swelling or periosteal thickening at the pain site and elevated local temperature. The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed because plain film radiographs may not reveal a stress fracture soon after the symptom onset; moreover, evidence of a fracture may never appear on plain radiographs. Triple phase nuclear bone scans and magnetic resonance imaging are more sensitive in the early clinical course than plain films for initial diagnosis.

Keywords

Fractures, stress – diagnosis, Tibia, Osteoarthritis

Hrčak ID:

77674

URI

https://hrcak.srce.hr/77674

Article data in other languages: croatian

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