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

Konstantinos Vlasis,Stavros Angelis,Dimitrios Filippou,Athanasios Papanikolaou,Alexandros Apostolopoulos

doi:10.7759/cureus.8616

Abstract

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.

Highlights

There are two types of stress fractures [1]
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
Chronic inflammatory disorders accompanied by suspicious clinical manifestations should be thoroughly inspected

Summary

Introduction

There are two types of stress fractures [1]. The most commonly reported and well-described type is the fatigue fracture that results from irregular or prolonged repetitive stress on normal bone. We report a case of simultaneous proximal tibia bilateral insufficiency fractures in a 51-year-old female patient with underlying psoriatic arthritis. As far as relevant past interventions are concerned, she reported that she did not seek immediate medical attention prior to her visit to the Outpatient Clinic, even though pain was extremely intense and not consistent with usual musculoskeletal discomfort she had experienced in the past, related to her medical condition (psoriatic arthritis) She reported utilization of non-steroidal anti-inflammatory drugs (NSAIDs), How to cite this article Vlasis K, Angelis S, Apostolopoulos A, et al (June 14, 2020) Bilateral Simultaneous Proximal Tibial Insufficiency Fractures in a Patient Suffering From Psoriatic Arthritis. Six weeks post-initiation of the protocol, the patient was encouraged to remove the casts At eight weeks, she reported no pain or discomfort, examination revealed no limitation of ROM or muscle mass loss and X-ray callus formation was visible (Figure 4). One year post-protocol initiation, no signs of tibial plateaus collapse were noted

Discussion

Conclusions

Disclosures

Harolds JA

Findings

12. Briot K