Nonunited insufficiency fracture of the proximal tibia and the distal femur treated by high tibial osteotomy in a patient under hemodialysis

Insufficiency fracture occurs when normal or physiological activity stresses a bone that is deficient in mineral or elastic resistance [1]. Insufficiency fractures are most often seen in elderly women with postmenopausal osteoporosis. However, it can occur in a variety of conditions in which the mineral content or the elasticity of bone is impeded, including osteoporosis of any cause, osteomalacia, hyperparathyroidism, rheumatoid arthritis, fluoride treatment, diabetes mellitus, fibrous dysplasia, Paget’s disease of the bone, and also renal osteodystrophy [1–3]. Insufficiency fractures most commonly occur in the pelvic girdle and in the sacrum [2]. In addition, the tibia is also a common site of insufficiency fractures [2]. The tibial insufficiency fractures are often treated by conservative measures, such as adequate rest, immobilization with casts or braces, analgesic agents, and reduced activities in daily living [3–5]; surgical treatments are rarely indicated unless the fractures do not heal or heal incorrectly [6–9]. Therefore, there is very little information available when adopting the surgical treatment to the proximal tibial insufficiency fractures [2]. Here, we report a case of nonunited insufficiency fracture of the proximal tibia with a marked varus deformity in a hemodialysis patient, which was complicated with a supracondylar insufficiency fracture of the ipsilateral femur. To our knowledge, correction osteotomy for such a case has not been reported previously. Our patient was informed and gave the consent that data concerning the case would be submitted for publication.