Tibial Stress Fracture

EpidemiologyTibial Stress Fracture

 

Athletic / high impact exercises

 

Aetiology

 

First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes

 

Signs

 

Point tenderness

- lateral aspect of tibia

 

Over time develop bony lump

 

X- ray

 

Often narrow medullary canal & thickened periosteum

- proximal third in adolescents

- runners typically at junction of middle and distal 1/3 

 

Tibial Stress FractureTibial Stress Fracture 2

 

Dreaded black line / fracture

 

Tibial Stress Fracture

 

 

 

Posteromedial Tibial Stress Fracture

 

On compression side

Better prognosis for healing

 

Posteromedial Tibial Stress Fracture

 

Biopsies 

 

Granulation tissue, fibrous vascular periosteum, underlying new bone formation

 

DDx

 

Osteoid Osteoma

Ewings

Osteogenesis Imperfecta

 

 

 

Issues

 

Can take a long time to heal

- up to 1 year

 

Can fracture

- which can go on to non union

 

Management

 

Non operative Management

 

Options

 

PTB / Rest

Ultrasound

ECSW

 

Operative Management

 

Options

 

Bone graft

Percutaneous drilling

IMN

Anterior Plating

 

IM Nail

 

Chang et al 1996 Am J Sports Med

- five cases of chronic tibial stress fractures

- army recruits with minimum 1 year non-op treatment

- reamed IM nail

- 3 proximally locked, 2 percutaneous corticotomies

- 1 lost to follow up

- 2 excellent results (unlimited pain free running)

- 3 good results (occasional pain with vigorous exercise)

- conclusions: safe, effective / no need to lock proximally / corticotomy not needed

 

Varner et al Am J Sports Med 2005

- 7 athletes treated with IM reamed nail

- united by 3 months

- return to sport by 4 months

- one patient developed bursitis at nail insertion site which settled with HCLA

- one patient developed a distal tibial traumatic fracture which healed non operatively

 

Anterior Plating

 

Borens et al J Orthop Trauma 2006

- 4 world class female athletes

- treated with anterior tension band plate

- no complications

- all healed and return to full sports at 10 weeks