Stress fractures result from repetitive mechanical loading that exceeds the capacity of bone remodeling and most commonly involve the tibial diaphysis in young active individuals. Stress fractures of the proximal tibia are less common, and fractures specifically occurring along the remnant of a completely fused growth plate are exceptionally reported.
We present the case of a 24-year-old woman who developed progressive knee pain over several weeks following an unusual increase in physical activity, including prolonged hiking. There was no history of acute trauma. Plain radiographs demonstrated a transverse linear abnormality involving the proximal tibia at the level of the physeal scar. Magnetic resonance imaging confirmed a stress fracture centered on and following the course of the completely fused proximal tibial physeal scar, with associated bone marrow edema.
The spatial correspondence between the fracture line and the physeal scar raises the possibility that the residual architecture of the former growth plate may influence stress distribution within the proximal tibia even after complete skeletal maturation. This case highlights an unusual pattern of stress fracture in a young adult and emphasizes the importance of recognizing the physeal scar as a potential site of stress-related osseous injury.
Keywords: stress fracture; fatigue fracture; proximal tibia; physeal scar; epiphyseal scar; growth plate; magnetic resonance imaging; young adult.
Citation: Jmal, M. M., Ben Ayech, H., & Laalla, E. M. (2026). When the physeal scar becomes a weak point: Proximal tibial stress fracture in a young adult. J Medical Case Repo 8(5):1-5.