Proximal tibial stress fracture in patients with advanced knee osteoarthritis: a narrative review

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.