Atraumatic Knee Marrow Edema-Like Signal Preceding a Low-Energy Bicondylar Tibial Plateau Fracture in a Patient with Crohn Disease: A Case Report.

​Bone marrow edema-like signal is a nonspecific magnetic resonance imaging finding whose clinical significance depends on its cause, distribution, associated structural abnormalities, symptoms, and skeletal risk. A 44-year-old construction engineer with Crohn disease and previous systemic corticosteroid exposure developed several weeks of atraumatic, load-related right-knee pain. Available prefracture radiographs showed no visible acute fracture. Noncontrast MRI on 28 July 2025 was reported as showing a medial femoral condyle marrow contusion without a fracture line or subchondral collapse; however, the limited coronal screenshots appeared discordant with the reported localization and were insufficient to establish the precise osseous epicenter without the complete DICOM study. Noncontrast computed tomography on 28 August showed maintained alignment without a visible fracture. Symptoms subsequently worsened during loading. On 22 September, a minor twisting movement while walking was followed by severe pain and inability to bear weight. Radiography and computed tomography demonstrated a comminuted bicondylar tibial plateau fracture, which the source narrative recorded as having been treated with open reduction and internal fixation. At approximately three months postoperatively, he reported no knee pain and had resumed normal walking and usual function; knee range of motion was full and painless. Dual-energy X-ray absorptiometry on 5 February 2026 showed bone mineral density below the expected range for age, with a lowest Z-score of -2.8 at the right total hip. Metabolic laboratory findings were largely within the displayed reference ranges, except for low vitamin B12. The case establishes a temporal sequence but cannot demonstrate direct anatomical progression or causality. Atraumatic marrow edema-like signal accompanied by worsening load-related pain in a patient with systemic skeletal risk factors may warrant diagnostic reassessment, reconsideration of loading, and an individualized bone-health evaluation.