Case reportBilateral tibial stress fracture presenting as painful edemas in lower limbs
Introduction
Stress fractures in the tibia are not uncommon in clinical practice, especially in rheumatologic patients, which constitute one of the most frequent types of stress fracture [1], [2], [3]. Nevertheless, in these patients the diagnosis of this process is often delayed or missed requiring a high grade of awareness, particularly in osteoporotic patients. Moreover, early diagnosis of these fractures is important, since although most of these fractures are uncomplicated, some of them may be complicated occasionally with delayed union or non-union problems or even complete fractures [4].
Although tibial stress fracture is a relatively common disorder, the development of a bilateral stress fracture is uncommon, and even more so in the clinical presentation as bilateral painful edemas in lower limbs. This report shows the case of a male with bilateral tibial stress fractures presenting as painful bilateral edemas in lower limbs associated with osteoporosis.
Section snippets
Case report
A 73-year-old man was seen in this department because of a 2-month history of a gradual onset of pain and edemas in both legs. The symptoms worsened with walking. He was previously seen at the cardiovascular department discarding peripheral vascular disease in lower limbs. There was no previous trauma, and the patient had not recently increased his activity level. He was receiving androgen deprivation therapy (ADT) with GnRH analogs for treatment of prostate cancer during the last 2 years.
Discussion
The present case shows various interesting aspects related to stress fractures, such as the unusual clinical presentation in the form of bilateral painful edemas in lower extremities, and the presence of an associated metabolic bone disease, in that case osteoporosis, which should always be studied in these patients. Although tibial stress fractures are relatively frequent in adult patients, bilateral tibial fractures are uncommon, only a few cases in athletes, children, patients with lower
References (14)
Insufficiency fractures of the distal tibia
Br. J. Rheumatol.
(1994)Stress fractures in rheumatologic practice: clinical significance and localizations
Rheumatol. Int.
(2002)- et al.
Insufficiency fractures in patients with chronic inflammatory joint diseases
Clin. Exp. Rheumatol.
(2002) - et al.
Bone stress injuries of the lower extremity: a review
Acta Orthop. Scand.
(2002) - et al.
Bilateral stress fractures of the anterior part of the tibial cortex
J. Bone Joint Surg.
(2000) - et al.
Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia
Skeletal Radiol.
(1999) - et al.
Tibial stress fracture mimicking neuroblastoma metastasis in two young children
Skeletal Radiol.
(1995)
Cited by (4)
Insufficiency fractures of bilateral distal tibias associated with chronic liver disease
2010, Journal of Orthopaedic ScienceTibial insufficiency fractures in rheumatoid arthritis: A new clinical sign
2012, Journal of RheumatologyBilateral tibial stress fractures in a young man associated with idiopathic osteoporosis
2010, Osteoporoz DunyasindanBilateral stress fracture of distal fibula and tibia - Case report
2008, Ortopedia Traumatologia Rehabilitacja