Regmi Anil, Pokharel Jhapindra, Kafle Pradeep, Regmi Rabindra
Department of Orthopaedics, Charak Memorial Hospital, Pokhara, Nepal.
Department of Orthopaedics, National Academy of Medical Sciences, Kathmandu, Nepal.
Indian J Orthop. 2025 Mar 19;59(5):694-701. doi: 10.1007/s43465-025-01366-w. eCollection 2025 May.
Stress fractures in the sagittal plane of the distal femur are rarely observed in clinical practice, particularly when occurring as a consequence of advanced knee osteoarthritis. This case report aims to highlight a rare presentation of sagittal plane stress fractures in the distal femur resulting from advanced knee osteoarthritis. It discusses the implications of this condition for both diagnosis and treatment, underscoring the need for heightened clinical awareness in patients with severe degenerative joint disease.
A 74-year-old female presented with bilateral osteoarthritis of knee Kellgren and Lawrence (KL) grade IV with a linear sagittal stress fracture of the distal femur. Unusual type of stress fracture was suspected on plane radiograph and confirmed on Magnetic Resonance Imaging (MRI). Bilateral total knee replacement was performed and screw augmentation was done for stress fracture. On one-year follow-up, patient was symptom-free, with no pain complaints. Knee range of motion was possible up to 0-100 degrees on the bilateral knee joint with no extensor lag.
Bilateral sagittal stress fractures of the distal femur secondary to osteoarthritis of the knee represent a rare but clinically significant pathology. Surgical intervention, by total knee replacement with adjunctive measures to stabilize the fractures, can effectively alleviate pain and improve functional outcomes in these patients.
V.
股骨远端矢状面应力性骨折在临床实践中很少见，尤其是由晚期膝关节骨关节炎导致的此类骨折。本病例报告旨在强调晚期膝关节骨关节炎导致的股骨远端矢状面应力性骨折的罕见表现。报告讨论了这种情况对诊断和治疗的影响，强调了对患有严重退行性关节疾病的患者提高临床认识的必要性。
一名74岁女性，患有双侧膝关节骨关节炎，Kellgren和Lawrence（KL）分级为IV级，股骨远端有线性矢状面应力性骨折。X线平片怀疑为不寻常类型的应力性骨折，磁共振成像（MRI）证实了这一诊断。进行了双侧全膝关节置换术，并对应力性骨折进行了螺钉增强固定。在一年的随访中，患者无症状，无疼痛主诉。双侧膝关节活动范围可达0至100度，无伸肌滞后。
膝关节骨关节炎继发的双侧股骨远端矢状面应力性骨折是一种罕见但具有临床意义的病理情况。通过全膝关节置换术及辅助措施稳定骨折的手术干预，可以有效缓解这些患者的疼痛并改善功能结局。
V级。
