Bilateral Stress Fractures of Amputated Tibial Stumps in the Setting of Chronic Compartment Syndrome

Abstract

Yurii Oleksiiovych Bezsmertnyi, Dmytro Vadymovych Bondarenko, Viktor Ivanovych Shevchuk, Halyna Viktorivna Bezsmertna Scientific Department, Scientific and Research Institute of Rehabilitation of National Pirogov Memorial Medical University, Vinnytsia, UkraineCorrespondence: Viktor Ivanovych Shevchuk, Email [email protected]: Limb amputation and subsequent prosthetics lead to significant disturbances in bone residual limb remodeling.Aim: To familiarize specialists with the possibility of simultaneous bilateral stress fractures of amputation residual limbs resulting from intensive loads and poor-quality prosthetics causing chronic compartment syndrome. A case of bilateral stress fractures of the tibia in a 28-year-old male military serviceman with paired transtibial amputation is presented. The fractures occurred in the process of active exploration of poorly fitting prostheses, complicated by chronic compartment syndrome that masked the clinical picture.Treatment: Rest, reopolyglucin, heparin 5000 U, furosemide, B vitamins, ascorbic acid, calcium, vitamin D, percutaneous electrical stimulation of muscles.Techniques: Radiography, ultrasound, blood biochemistry, measurement of subfascial pressure.Outcomes: After treatment, the phenomena of compartment syndrome disappeared, stress fractures healed, new receiving sleeves of prostheses were made, gradual dosed loads were started. 7 months after the diagnosis of stress fractures and compartment syndrome, the patient started using the prosthesis without aids. Examined 18 months later. Worked as a warehouse manager, walking an average of 4 km per day.Conclusion: With complaints from the patient with an amputation stump of muscle and bone pain that appeared after exercise, passed after rest, and reparative reaction detected on radiographs, functional overstrain of the bone should be suspected, which can potentially lead to a stress fracture. The causes of stress fractures in the patient were acute overstrain of the bone tissue during prosthesis development, noncompliance with the loading and resting regimes, and local disturbance of the bone blood supply due to the narrowed rigid socket of the prosthesis. Stress fractures of the bone tissue of the amputation stump contain elements of insufficiency and fatigue. Chronic compartment syndrome may exacerbate and mask the stress fracture.Keywords: transtibial amputation, stress fracture, compartment syndrome, prosthesis

Keywords

• transtibial amputation
• stress fracture
• compartment syndrome
• prosthesis