Identification of a high-risk anterior tibial stress fracture

The patient was a deployed 34-year-old female soldier with a chief complaint of bilateral anterior shin pain for the past 8 weeks. Due to concern for a stress fracture, radiographic views of the bilateral tibia and fibula were completed, which revealed cortical thickening through the anterior midtibial regions bilaterally, consistent with stress reactive changes. Furthermore, a transverse lucency through the anterior cortex of the anterior right midtibial region was noted, which was consistent with a stress fracture. The patient was immediately placed in a short leg cast and was given strict non-weight-bearing instructions for gait. She was subsequently evacuated to her home duty station for consultation with an orthopaedic surgeon to determine if surgical intervention was warranted. This report illustrates the importance of identifying stress fractures considered to be high risk.