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Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report.

Kurklu M, Ozboluk S, Kilic E, Tatar O, Ozkan H, Basbozkurt M - Cases J (2010)

Bottom Line: Clinical suspicion is essential for the diagnosis.A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march.History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired.

View Article: PubMed Central - HTML - PubMed

Affiliation: GATA Department of Orthopedics and Traumatology, Etlik, Ankara, Turkey.

ABSTRACT
Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture.

No MeSH data available.


Related in: MedlinePlus

Oval-shaped increased osteoblastic activity on the metaphyseal region of both tibias (arrows).
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Figure 2: Oval-shaped increased osteoblastic activity on the metaphyseal region of both tibias (arrows).

Mentions: The patient was 20 years-old male private, recruited 35 days ago, with no history of previous bone or joint disease. One month before development of symptoms, he started training for ceremonial march which typically involved violent foot strikes on concrete ground and lasted for at least one hour. He experienced right knee pain at 13th day and left knee pain at 15th day of training. Initially (within the first three days) pain was felt only during ceremonial march, which relieved during rest or activities of daily life. Later, pain became persistent during the activities of daily life. His first radiographs of both knees (at the 18th day) showed no pathology. At his physical examination performed at the first month, his left knee was painful and extension was restricted for the last 10 degrees while flexion was restricted for the last 20-25 degrees; his right knee was also painful and extension was restricted for the last 15-20 degrees while flexion was restricted for the last 20 degrees. Medial sides of his both knees were tender on palpation and pain was elicited during varus and valgus stress tests. X-rays of both knees showed transverse sclerotic lesions and cortical thickening at the medial plateaus (Figure-1). Three-phase bone scintigraphy (Tc99m MDP) performed to disclose a stress fracture showed an increased osteoblastic activity of oval-shape at the medial side of tibial metaphysis (Figure-2). MRI showed a fracture line with an intraarticular extension and bone marrow edema that surrounded the fracture (Figure-3).


Stress fracture of bilateral tibial metaphysis due to ceremonial march training: a case report.

Kurklu M, Ozboluk S, Kilic E, Tatar O, Ozkan H, Basbozkurt M - Cases J (2010)

Oval-shaped increased osteoblastic activity on the metaphyseal region of both tibias (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2807419&req=5

Figure 2: Oval-shaped increased osteoblastic activity on the metaphyseal region of both tibias (arrows).
Mentions: The patient was 20 years-old male private, recruited 35 days ago, with no history of previous bone or joint disease. One month before development of symptoms, he started training for ceremonial march which typically involved violent foot strikes on concrete ground and lasted for at least one hour. He experienced right knee pain at 13th day and left knee pain at 15th day of training. Initially (within the first three days) pain was felt only during ceremonial march, which relieved during rest or activities of daily life. Later, pain became persistent during the activities of daily life. His first radiographs of both knees (at the 18th day) showed no pathology. At his physical examination performed at the first month, his left knee was painful and extension was restricted for the last 10 degrees while flexion was restricted for the last 20-25 degrees; his right knee was also painful and extension was restricted for the last 15-20 degrees while flexion was restricted for the last 20 degrees. Medial sides of his both knees were tender on palpation and pain was elicited during varus and valgus stress tests. X-rays of both knees showed transverse sclerotic lesions and cortical thickening at the medial plateaus (Figure-1). Three-phase bone scintigraphy (Tc99m MDP) performed to disclose a stress fracture showed an increased osteoblastic activity of oval-shape at the medial side of tibial metaphysis (Figure-2). MRI showed a fracture line with an intraarticular extension and bone marrow edema that surrounded the fracture (Figure-3).

Bottom Line: Clinical suspicion is essential for the diagnosis.A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march.History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired.

View Article: PubMed Central - HTML - PubMed

Affiliation: GATA Department of Orthopedics and Traumatology, Etlik, Ankara, Turkey.

ABSTRACT
Stress fractures are caused by repetitive microtraumas that occur during unusual or increased activities. Clinical suspicion is essential for the diagnosis. A twenty-years old soldier was presented with bilateral knee pain and restriction of knee movements after a period of training for ceremonial march. Although plain X-rays were normal, scintigraphy and MRI revealed stress fractures at metaphyseal region of both tibias. History of a patient presenting with persisting joint or bone pain after an unusual repetitive activity should be delicately inquired. Typical history, although pain might be localized to unusual sites, should raise the suspicion of a stress fracture.

No MeSH data available.


Related in: MedlinePlus