Case Reports

Incidental Asymptomatic Fibular Stress Fractures Presenting as Varus Knee Osteoarthritis: A Case Report

Publish date: December 5, 2018
By
Taylor J. Freetly, MS
Yair D. Kissin, MD, FAAOS
Andrew Carbone, MD
Michael A. Kelly, MD
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TAKE-HOME POINTS

  • Proximal fibular stress fractures in patients with primary osteoarthritis and fixed varus deformity have rarely been reported.
  • Stress fractures occurring near the knee in the setting of a varus deformity generally occur on the compression side of the tibia and are symptomatic.
  • Proximal fibular stress fractures may present as an incidental finding of an expansile deformity on plain films in patients with varus osteoarthritic knees.
  • Magnetic resonance imaging is rarely indicated in the evaluation of degenerative joint disease; however, it was justified in our case to rule out neoplasm.
  • When present in the setting of an osteoarthritic varus knee, stress fractures of the proximal fibula should heal with conservative treatment and should not affect the plan or outcome of TKA.


 

References

ABSTRACT

Stress fractures are often missed, especially in unusual clinical settings. We report on 2 patients who presented to our orthopedic surgery clinic with incidental findings of asymptomatic proximal fibular tension side stress fractures in severe longstanding varus osteoarthritic knees. Initial plain films demonstrated an expansile deformity of the proximal fibular shaft, and differential diagnosis included a healed or healing fracture versus possible neoplasm. Magnetic resonance imaging with and without gadolinium was utilized to rule out the latter prior to planned total knee arthroplasty.

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