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Case Reports
. 2015 Jul-Sep;5(3):75-7.
doi: 10.13107/jocr.2250-0685.315.

Isolated Proximal Fibular Stress Fracture In Osteoarthritis Knee Presenting As L5 Radiculopathy

Kothari Manish K  1 , Tikoo Agnivesh  1 , Saini Pramod P  2 , Dalvie Samir S  2
Affiliations
Case Reports

Isolated Proximal Fibular Stress Fracture In Osteoarthritis Knee Presenting As L5 Radiculopathy

Kothari Manish K et al. J Orthop Case Rep. 2015 Jul-Sep.

Abstract

Introduction: Isolated proximal fibular stress fractures are rare and usually seen only in athletes and military recruits. Its occurrence with osteoarthritis of the knee is not documented. Diagnosis of stress fractures is not difficult, but they can mimic other pathologies at times.

Case report: A 45-year-old male patient presented with pain and paresthesias in left lower thigh and leg. He was previously treated as L5 radiculopathy confirmed with lumbar spine magnetic resonance imaging (MRI). He received analgesics followed by nerve root blocks at another center. He was referred to our center for L4-5 root decompression. Due to atypical spine symptoms, leg radiographs and MRI was done, which showed isolated stress fracture of the left proximal fibula.

Conclusion: We conclude that isolated stress fractures of the proximal fibula can present as L5 radiculopathy. A high level of suspicion is required for diagnosis. MRI is the investigation of choice when in doubt.

Keywords: Fibula/injuries; fractures; knee; osteoarthritis; radiculopathy; stress/diagnosis; stress/etiology.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
T2-weighted magnetic resonance imaging left paracentral sagittal section showing herniation of L4-5 disc.
Figure 2
Figure 2
T2-weighted magnetic resonance imaging axial section at L4-5 disc level showing bilateral severe lateral recess stenosis with hypertrophied left superior facetal process
Figure 3
Figure 3
Clinical picture showing varus deformity of the left knee.
Figure 4
Figure 4
Standing anteroposterior radiograph of the left knee showing features of osteoarthritis. Callus is seen in the proximal third of the fibula.
Figure 5
Figure 5
Standing lateral radiograph of the left leg showing callus formation in the proximal fibula. A faint fracture line is also seen.
Figure 6
Figure 6
Magnetic resonance imaging image (a) short tau inversion recovery sequence, sagittal section showing the fracture line along with marrow edema and periosteal edema. (b) T2-weighted axial section at the level of the stress fracture showing irregular endosteal and periosteal surface with marrow and periosteal edema.
Figure 7
Figure 7
T2-weighted axial section at the level of the stress fracture showing the absence of any soft tissue.
See this image and copyright information in PMC

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