Elsevier

Joint Bone Spine

Volume 73, Issue 5, October 2006, Pages 557-559
Joint Bone Spine

Case report
Bilateral tibial stress fracture presenting as painful edemas in lower limbs

https://doi.org/10.1016/j.jbspin.2005.11.023Get rights and content

Abstract

Bilateral stress fracture of the tibia is infrequent. This paper presents an unusual case of a 73-year-old man who sustained a bilateral stress fracture of the tibia presenting as painful edemas in lower limbs. The radiographic and scintigraphic examination confirmed the diagnosis of the fractures. In addition, the patient was receiving androgen deprivation therapy with GnRH analogs for the treatment of prostate cancer and the bone density measurements confirmed the presence of osteoporosis. Treatment with restricted weight bearing was associated with improvement of clinical symptoms. Early recognition and diagnosis of this injury is essential for treating the underlying osteoporosis as well as the fracture.

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

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