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

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.

Figure 1

Anteroposterior radiographs show transverse sclerotic lesions on metaphyseal region of both tibias (arrows) where left one extends into the tibial plateau.

Figure 2

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

Figure 3

Coronal MR images show a fracture line at the medial side of left tibia which extends into the lateral half. Fracture at the right side extends into the articular surface.