Single-stage Management of Advanced Bilateral Knee Osteoarthritis with Stress Fracture of Medial Malleolus.

Introduction: Stress fractures occur due to abnormal increased or repetitive stress on a normal bone. These have been described in sports persons or military personnel involved in strenuous physical activities. Stress fractures occurring as a result of undue stress due to deviated mechanical axis usually involve the proximal tibia and fibula and have rarely been described in the literature.

Case Report: We report a case of the left medial malleolus stress fracture secondary to advanced knee osteoarthritis (OA) with severe varus deformities. Mechanical malalignment like severe genu varus deformity is a risk factor for a stress fracture in knee OA. A single-staged management by the surgical treatment of stress fracture, along with the correction of underlying knee deformity by bilateral simultaneous total knee arthroplasty of this case is discussed. We also describe the pathomechanics involved in this injury in the present case report.

Conclusion: Stress fractures associated with knee OA can be found in the ankle as well. Detailed history and clinical examination can help in diagnosing this condition. It is also important to correct the overall mechanical alignment of the knee to provide an adequate environment for fracture healing.