Primary diaphyseal tuberculosis of the tibia, presenting as a pathological fracture – A case report

Isolated involvement of the shaft of a long bone is a rare presentation of skeletal tuberculosis (TB). To our knowledge, primary skeletal TB of the tibia manifesting as a pathological fracture has not been widely reported. We report a case of primary TB of the right tibia in an immunocompetent 85-year-old woman. An immunocompetent 85-year-old woman with tuberculosis osteomyelitis of her right tibia and fibula, presenting as pathological fracture. Fibular ostectomy was performed followed by application of a bioabsorbable bone substitute and an Ilizarov external fixator. The patient was pain-free and ambulating with a walking frame one year post-operatively. Tuberculosis osteomyelitis is challenging to diagnose due to the absence of distinctive clinical and radiographic features. This case highlights the potential of a bioabsorbable bone substitute in achieving osteoconduction and providing sustained local antimicrobial release in tuberculous osteomyelitis. • Primary tuberculosis infection is a differential diagnosis for pathological fractures in long bone. • Staining and culture of acid-fast bacilli may show false negative results, polymerase chain reaction (PCR) can aid diagnosis. • Bioabsorbable bone substitute may treat tuberculosis osteomyelitis by osteoconduction and sustained release of antibiotics.