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Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A

Tjl Tan¹, Wls Ho¹

¹Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.

Malaysian Orthopaedic Journal

|June 15, 2017

Abstract:

Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA) bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

Keywords:

Tibial stress fracture methotrexate osteopathy total knee arthroplasty

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