Stress fracture
Today’s Case of the week involves a 59-year-old amateur runner who reports persistent pain in his left knee. The patient completes an average of 20-30km per week, and there is almost always a significant increase in pain after longer training sessions.
Symptoms
The patient reported that the pain was initially mild and occurred during walking, but subsided with periods of rest. Recently, however, the symptoms have worsened and the pain is now present even at rest.
Clinical examination reveals tenderness in the internal aspect of the left tibial plateau. The pain intensifies with running and jumping loads on the affected leg. Knee mobility is slightly limited, but there are no obvious signs of instability or joint block.
In runners, this type of stress fracture often occurs due to repetitive stress and overloading of the bone. In particular, the intense training and increased running mileage may have led to overuse of the medial tibial plateau.
MRI demonstrates a horizontal fracture of the internal tibial plateau with associated bone marrow edema.
Treatment
Initial treatment usually consists of rest and restriction of weight bearing on the affected leg. The patient is instructed to stop running for the time being and instead switch to gentler activities such as swimming or cycling. Physical therapy helps strengthen the surrounding muscles and promote recovery.
In more severe cases or when symptoms persist, conservative therapy may not be sufficient, and surgical intervention, such as screw fixation or plate osteosynthesis, may be required to stabilize the fracture. If a bow-leg deformity (genu varum) is present, as in our patient, a leg axis correction can reduce the load.
Forecast
The prognosis for a fatigue fracture is usually good if adequate rest is taken and loading is resumed gradually. However, it is important that the patient be patient and follow the recommendations of the treating physician to ensure a full recovery and avoid future injury.
