Srinivasan Suresh, Kurup Harish
Department of Orthopaedics, Pilgrim Hospital, Boston, Lincolnshire, UK.
BMJ Case Rep. 2017 Sep 7;2017:bcr-2017-221206. doi: 10.1136/bcr-2017-221206.
We present a case of fibular insufficiency (stress) fracture in a patient with pre-existing asymptomatic advanced tibialis posterior dysfunction. The patient had severe planovalgus (flat foot) deformity but no pain before the injury; hence had never sought any treatment. She was first treated conservatively for the fracture which failed to control the deformity and had ongoing symptoms. She eventually required tibio-talo-calcaneal fusion. To the best of our knowledge, this is the first case report of this condition in the English literature. In patients with severe tibialis posterior dysfunction, weight-bearing axis passes directly from calcaneum to fibula making it vulnerable to fracture. Patients should be made aware of this risk even if they are asymptomatic and encouraged to use orthotic support for protection against insufficiency fractures.
我们报告一例存在无症状的晚期胫后肌功能障碍的患者发生腓骨应力性骨折的病例。该患者有严重的扁平外翻（扁平足）畸形，但受伤前无疼痛，因此从未寻求过任何治疗。她最初接受了骨折保守治疗，但未能控制畸形且症状持续存在。她最终需要进行胫距跟融合术。据我们所知，这是英文文献中关于这种情况的首例病例报告。在严重胫后肌功能障碍的患者中，负重轴直接从跟骨传至腓骨，使其易发生骨折。即使患者无症状，也应告知其这种风险，并鼓励他们使用矫形支具以预防应力性骨折。
