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Tibial Stress Fracture after a Graft Has Been Obtained from the Fibula. A Report of Five Cases*
SANFORD E. EMERY, M.D.†, CLEVELAND; JOHN G. HELLER, M.D.‡, DECATUR; CHERYL A. PETERSILGE, M.D.†, CLEVELAND, OHIO; MICHAEL J. BOLESTA, M.D.§; THOMAS E. WHITESIDES, JR., M.D.‡, DECATUR, GEORGIA
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Investigation performed at the Departments of Orthopaedic Surgery, Case Western Reserve University, Cleveland, and Emory University School of Medicine, Decatur
J Bone Joint Surg Am, 1996 Aug 01;78(8):1248-51
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Stress fractures of the lower extremity may result from overuse of normal bone or from normal loading of structurally deficient bone. Stress fractures of the pelvis have been reported as a complication after a bone graft has been obtained from the iliac crest4. Han et al. reviewed the cases of 160 patients who had had a vascularized bone transfer. Of the 132 patients who had had a fibular transfer, one had a tibial stress fracture but no follow-up information was provided. To our knowledge, no reports have addressed only fatigue failure of the tibia after the attainment of a graft from the fibula. We report the cases of five patients who had a tibial stress fracture after a graft had been obtained from the ipsilateral fibula for use in anterior reconstruction of the spine. Patients who have persistent or recurrent pain in the leg after a graft has been obtained from the fibula should be evaluated for a possible stress fracture of the tibia.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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