Type 2 Diabetes Mellitus and Bilateral Atraumatic Tibial Osteonecrosis with Fracture: A Case Report

Abstract

Osteonecrosis is defined as cell death of the components of bone. The etiologies of osteonecrosis are miscellaneous. A possible mechanism of osteonecrosis may be intraosseous fat embolism leading to focal intravascular coagulation and osteonecrosis. Many diseases are associated with or lead to osteonecrosis, including metabolic disease. Type 2 diabetes mellitus is well known for its association with microvascular and macrovascular complications, but it has rarely been associated with bilateral atraumatic tibial osteonecrosis and fracture. A 46-year-old Chinese man presented with painful swelling of his right knee for two months. X-ray revealed a tibial plateau fracture. Magnetic resonance imaging showed a comminuted fracture of the proximal tibia. The patient underwent a right total knee replacement. Five months later, the same condition was noted in his left knee. There was no history of trauma can be traced. Eight months later, he developed septic arthritis of both knees in the previous replacement regions. Thereafter, he was admitted to the hospital seven more times due to septic arthritis, and underwent debridement, sequestrectomy and right above-knee amputation. Finally, two years and nine months after his first admission, he expired due to pneumonia and septic shock. In conclusion, type 2 diabetic patients, with long duration and poor control of blood sugar, have the possibility to associate with bilateral atraumatic tibial osteonecrosis and fracture with poor outcome.