Bilateral Tibia Stress Fractures: Case Report and Review of the Literature

Abstract

Background: Tibia stress fractures are microscopic fractures of the tibia that are often the result of repetitive microtrauma as commonly seen in military recruits and intense athletics. Tibia stress fractures are more commonly unilateral and are usually in the diaphyseal portion of the tibia. We describe a case of bilateral medial proximal tibia occult fractures along the epiphyseal scar following blunt trauma. Case description: A 41-year-old bipolar male presented to the clinic one-week following a pedestrian versus motor vehicle accident. He subsequently developed low back pain and bilateral knee pain. The diagnosis of bilateral proximal tibia fractures was made using repeat plain X-ray films two-weeks after initial presentation. Operative treatment with bilateral medial tibia internal fixation was elected and the patient was discharged full weight-bearing. Literature review: There have been two case reports which explored the treatment options for bilateral proximal tibia fractures. Neither case elected to treat with internal fixation. Clinical relevance: Because the incidence of bilateral tibia stress fractures is low and operative treatment with bilateral internal fixation has not been reported, our case examines the viability of operatively treating bilateral tibia stress fractures with internal fixation. Our case demonstrates the successful treatment of bilateral medial proximal tibia occult fractures with internal fixation.