Fibula proksimalinde stres kırığı: Olgu sunumu
Amaç: Stres kırıkları genellikle sporcularda ve acemi erlerde karşılaşılan bir durumdur. Genellikle tibia ve metatarslarda görülür. Fibulada da görülmekle beraber kemiğin proksimal bölümünde nadirdir. Çalışmanın amacı fibula proksimalinde nadir görülen stres kırıklı bir olgunun sunulmasıdır. Olgu sunumu: Elli yaşındaki kadın hasta birkaç haftadır aktivite ile artan bacak ağrısı şikayetiyle başvurdu. Herhangi bir travma tarif etmiyordu. Bacağın lateral bölümünde hassasiyet vardı. Yapılan incelemeler ve alınan tru-cut biopsi sonucunda fibula proksimalinde stres kırığı tanısı konuldu. Üç haftalık atel tedavisi ve ardından kısmi yük verdirilerek tedavi edilen hastanın iki ay sonra herhangi bir şikayeti kalmadı ve normal günlük aktivitesine döndü. Sonuç: Stres kırıkları fibula proksimalinde nadir görülür. Bu kırıkların klinik ve radyolojik görünümü kemik tümörleri ile karışabilmektedir. Tanı koymak bazen zor olabilir. Gerekli durumlarda biyopsi alınabilir.
Stress fracture in the proximal fibula: A case report
Objective: Stress fractures are common injuries in athletes and soldiers. The most common locations are the tibia and the metatarsals. Although stress fractures of the fibula are not uncommon, they are rare in the proximal one-third. The purpose of this study was to report a rare case of stress fracture in proximal third of fibula. Case report: A 50-year-old female complained of a history of leg pain with activity that had been present for several weeks. There was no history of direct trauma. Tenderness was found over the lateral aspect of the leg. Radiological examination and tru-cut biopsy of the lesion revealed stress fracture of the proximal fibula. After 3 weeks of casting followed by partial weight bearing, the symptoms disappeared and the patient returned to normal activity. Conclusion: Stress fractures rare in the proximal one-third of the fibula. The similar clinical and radiological early course of stress fractures and bone tumors can lead to diagnostic misinterpretation. Biopsy is indicated in such conditions.
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- 1. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes. A study of 320 cases. Am J Sports Med 1987;15:46–58.
- 2. Giladi M, Ahronson Z, Stein M, Danon YL, Milgrom C. Unusual distribution and onset of stress fractures in soldiers. Clin Orthop 1985;192:142–6.
- 3. Iwamoto J, Takeda T. Stress factures in athletes J Orthop Sci 2003;8:273–8.
- 4. DiFiori JP. Stress fracture of the proximal fibula in a young soccer player: A case report and a review of the literature. Med Sci Sports Exerc 1999;31:925-8.
- 5. Peris P. Stress fractures in rheumatological practice: Clinical significance and localizations. Rheumatol Int 2002;22:77–9.
- 6. Bennell KL, Brukner PD. Epidemiology and site specificity of stress fractures. Clin Sports Med 1997;16:179-96.
- 7. Csizy M, Babst R, Fridrich KS. ‘Bone tumor’ diagnostic error in stress fracture of the medial tibial plateau Unfallchirurg 2000;103:993–5.
- 8. Romero J, Exner GU, Hodler J, von Hochstetter AR. Fatigue fracture as a tumor-simulating lesion. Differential diagnostic delimitation using proton spin tomography Z Orthop Ihre Grenzgeb 1991;129:305–12.
- 9. Zwas ST, Elkanovitch R, Frank G. Interpretation and classification of bone scintigraphic findings in stress fractures. J Nucl Med 1987;28:452–7.
- 10. Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG. Scintigraphic uptake of 99mTc at non-painful sites in athletes with stress fractures. The concept of bone strain. Sports Med 1987;4:65–75.
- 11. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995;23:472–81.
- 12. Connolly LP, Connolly SA, Treves ST. Differentiation of anterior tibial stress fracture from osteoid osteoma. Clin Nucl Med 2001;26:54–6.
- 13. Keating JF, Beggs I, Thorpe GW. Three cases of longitudinal stress fracture of the tibia. Acta Orthop Scand 1995;66:41–2.