Bilateral Proximal Tibia Stress Fractures through Persistent Physes

Figure 3

(a) Left proximal tibia specimen showing fragments of nonossifying hyaline cartilage with admixed fibroconnective tissue consistent with persistent physis (H&E; 200x). Histological examination of the left proximal tibia tissue specimen showed fracture callus comprising mixed chondroid/fibroconnective tissue undergoing ossification. Examination of the right proximal tibia tissue specimen obtained six weeks later demonstrated numerous admixed fragments of purple to purple-gray staining myxochondroid matrix suggestive of chondroid metaplasia, which is not an expected finding in this anatomic location distal to the articular surface. This presence of cartilage at this location is again consistent with a persistent physis. (b) An intraoperative photograph of right proximal tibia status post debridement of fibrous material at the site of prior physis.

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