21yo active duty military recruit continued to run despite continually worse lef

Question

21yo active duty military recruit continued to run despite continually worse left tibial shaft pain. Pain in left tibial shaft was worse with weightbearing activities and better with rest. One day before OCS (Officer Candidate School) graduation the patient went for a run and sustained an injury that required ambulance transportation to the ED. The patient subsequently underwent surgical intervention. Presented are his 6 month postoperative X-rays. Provide a synopsis of the patient’s pathology, how that pathology contributed to his symptoms and eventual treatment.   Be thorough.

Explanation / Answer

Fractures of tibia are often associated with fracture of fabula. The skin and subcutaneous tissues over the anterior and medial tibia are very thin and therefore lower leg fractures are often open. The assessment includes-

X-RAY must show the whole length of tibia and fabula. Check for the associated injuries to the knee and ankle.

CT scan may be required if X-RAY is inadequate to make definitive assessment and for proximal tibial fractures.

Bone scanning and MRI scans are more sensitive in diagnosing stress fractures.

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