Late Onset Atypical Fracture Resulting from a Neglected Tibia Malunion: A 45-Year Case Study

Introduction Neglected or inadequately treated fractures can lead to complications such as malunion, non-union, deformities, and fractures under atypical conditions that mimic pathological fractures due to biomechanical alterations and reduced bone density. Despite numerous case studies, the long-term consequences of neglected tibial malunions remain underexplored. This case report delves into the outcomes of a neglected tibia fracture malunion manifesting after an extended period. Case A 65-year-old male presented with severe shin pain and tingling, rendering him unable to walk. The patient had no history of recent falls, trauma, or accidents. However, his medical history included a tibia fracture from a motorcycle accident 45 years earlier, which was treated solely by traditional bone setters. This initial neglect resulted in a malunion, causing a leg length discrepancy and instability. During examination, a deformity on the right shin, tenderness, visible leg length asymmetry, and limited range of motion were noted. The patient’s bone mineral density (BMD) was measured at -2.8. X-rays indicated a lateonset atypical fracture associated with malalignment and significantly reduced bone density. Conclusion This case highlights the severe complications that can arise from neglected malunion fractures, including atypical fractures resembling pathological conditions, which are primarily due to biomechanical changes rather than disease. It underscores the importance of timely medical intervention and illustrates the risks associated with reliance on traditional bone-setting methods. This case is particularly instructive for trauma care in developing nations, where such practices are more common and often go unaddressed. Bangladesh Journal of Medical Science Vol. 24 No. 02 April’25 Page : 663-669