Review Question - QID 210608

A 19-year-old African American man presents to his primary care provider for left leg pain. He reports a 2-month history of slowly progressive pain in the middle of his left leg. The pain is dull and gets much worse at night. He took some over-the-counter aspirin which seemed to improve his pain temporarily. His past medical history is notable for rheumatoid arthritis and asthma. He takes methotrexate and uses an albuterol inhaler as needed. His family history is notable for gout and rheumatoid arthritis in his father. His temperature is 98.8°F (37.1°C), blood pressure is 117/68 mmHg, pulse is 72/min, respirations are 16/min, and oxygen saturation is 99% on room air. On exam, he has mild localized tenderness to palpation along the anteromedial aspect of the tibial shaft. He has 5/5 strength throughout his left lower extremity with 2+ patellar and Achilles reflexes. Sensation to light touch is intact in the saphenous, sural, deep peroneal, superficial peroneal, and tibial distributions. A radiograph of the patient's right leg is shown in Figure A. This patient most likely has which of the following lesions?