A non-traumatic stress fracture of the tibial plateau following a marathon race: A rare case report

In recent years, the number of sports injuries in Taiwan has increased owing to a dramatic increase in the popularity of running marathons. Most tibial stress fractures occur at the posteromedial aspect of the middle third of the tibial shaft, and other less common sites of this fracture are the anterior cortex and medial malleolus. Here we report a 59-year-old man with a stress fracture located in an unusual region -- the tibial plateau, following a marathon race. The patient presented with anterior knee pain and had ＂negative＂ radiographs. Magnetic resonance imaging showed a stress fracture of the proximal tibia and partial tears of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament. He was treated conservatively considering the appropriate alignment of the fracture without any displacement. A long-leg splint was used, and no weight bearing was allowed on the affected leg for 9 weeks. Healing was monitored with a series of follow-up radiographs that showed sclerosis with endosteal change over the proximal tibia. The fracture eventually healed without any complications. Orthopedic surgeons should consider the possibility of a tibial plateau fracture in the context of non-traumatic knee pain after a marathon race or other high-loading activity, even if radiographs do not demonstrate a fracture. This will help in the early diagnosis and treatment of this stress fracture.