Tibial shaft fractures in amateur footballers

Return to Sport After Tibial Shaft Fractures: A Systematic Review

CONTEXT

Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods.

OBJECTIVE

To determine the current evidence for the treatment of and return to sport after tibial shaft fractures.

DATA SOURCES

OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014.

STUDY SELECTION

Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non-English language were excluded.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis.

RESULTS

A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, -83.36 to -55.64; P < 0.01). Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P < 0.01).

CONCLUSION

The general principles are to undertake surgical management for displaced fractures and to attempt nonsurgical management for undisplaced fractures. Primary surgical intervention of undisplaced fractures, however, may result in higher return rates and shorter return times, though this exposes the patient to the risk of surgical complications, which include surgical site infection and compartment syndrome.

The epidemiology, morbidity, and outcome of soccer-related fractures in a standard population

BACKGROUND

Soccer is the most common cause of sporting fracture, but little is known about patient outcome after such fractures.

PURPOSE

To describe the epidemiological characteristics of soccer-related fractures, their outcomes, and the likelihood of return to soccer after injury in a known United Kingdom population at all skill levels.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

All soccer fractures during 2007-2008 in the Lothian population were prospectively collected, with the diagnosis confirmed by an orthopaedic surgeon when patients attended the only adult orthopaedic service in Lothian. Patients living outside the region were excluded from the study. Patients were contacted in August 2010 to ascertain their progress in returning to soccer.

RESULTS

A total of 367 fractures were recorded over the study period in 357 patients; 312 fractures (85%) in 303 patients (85%) were followed up, with a mean interval of 30 months (range, 24-36 months). The mean time for return to soccer from injury was 15 ± 17 weeks (range, 0-104 weeks). For patients with lower limb injuries, the mean time was 26 ± 22 weeks (range, 4-104 weeks) compared with 9 ± 8 weeks for patients with upper limb injuries (range, 0-64 weeks). Fourteen percent of the whole cohort did not return to soccer; 83% returned to soccer at the same level or higher. Thirty-nine percent had ongoing related problems; however, only 8% had impaired soccer ability because of these problems. Fractures with the highest morbidity in not returning to soccer were to the clavicle (24%), distal radius (21%), and tibial diaphysis (20%).

CONCLUSION

Most patients sustaining a fracture while playing soccer will return to soccer at a similar level. While over one third of them will have persisting symptoms 2 years after injury, for the majority, this will not impair their soccer ability.

Tibial shaft fractures in football players

Background

Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences.

Methods and Results

A retrospective study of all tibial football fractures that presented to a teaching hospital was undertaken over a 5 year period from 1997 to 2001. There were 244 tibial fractures treated. 24 (9.8%) of these were football related. All patients were male with a mean age of 23 years (range 15 to 29) and shin guards were worn in 95.8% of cases. 11/24 (45.8%) were treated conservatively, 11/24 (45.8%) by Grosse Kemp intramedullary nail and 2/24 (8.3%) with plating. A difference in union times was noted, conservative 19 weeks compared to operative group 23.9 weeks (p < 0.05). Return to activity was also different in the two groups, conservative 27.6 weeks versus operative 23.3 weeks (p < 0.05). The most common fracture pattern was AO Type 42A3 in 14/24 (58.3%). A high number 19/24 (79.2%) were simple transverse or short oblique fractures. There was a low non-union rate 1/24 (4.2%) and absence of any open injury in our series.

Conclusion

Our series compared similarly with the few reports available in the literature. However, a striking finding noted by the authors was a drop in the incidence of tibial shaft football fractures. It is likely that this is a reflection of recent compulsory FIFA regulations on shinguards as well as improvements in the design over the past decade since its introduction.

Calf muscle wasting after tibial shaft fracture

OBJECTIVES

To study the long term effect of tibial shaft fractures treated by immobilisation in a long leg cast on the calf muscle bulk.

METHODS

Computed tomography scans were performed at fixed points on the lower legs of 23 non-professional athletes who sustained closed tibial fractures 16 years previously. Length of immobilisation was determined from the hospital records. All the fractures were treated non-operatively. The cross sectional area of the various leg compartments was measured and compared with the non-injured leg.

RESULTS

There was a significant reduction in cross sectional area of the posterior compartment (p<0.001, Student's t test). No such difference was seen in the anterolateral compartment.

CONCLUSION

Tibial fractures treated non-operatively are associated with significant long term calf muscle wasting.

Effect of Body Armor on Simulated Landmine Blasts to Cadaveric Legs

BACKGROUND

Antipersonnel landmine protective footwear relies on blast deflection or on exaggerated standoff between the foot and the explosive. Neither design has been tested for clinical effectiveness.

METHODS

4 cadaveric lower extremities--3 fitted with a Koflach boot incorporating TABRE (Technology for Attenuating Blast Related Energy) were subjected to controlled blast with charges of up to 100 g trinitrotoluene (TNT). The blasts were recorded by a digital recording system. All legs were X-rayed and underwent computed tomography scanning before and after testing.

RESULTS

TABRE-protected limbs directly subjected to the blast hyperextended at the knee during firing. Injuries showed a pattern of open tibial fractures (Gustilo grade I, II), of multiple calcaneal (Sanders Type III, IV), and fibular fractures and of the tibial plateau, but showed no traumatic amputation.

CONCLUSIONS

Development of protective footwear against landmine blast is feasible. From medium mines up to charges of 100 g TNT limb salvage may be possible.

The unreamed intramedullary tibial nail in tibial shaft fractures of soccer players: a prospective study

Lower leg fractures are common and complex injuries in soccer players. Twenty-five mainly recreational soccer players who sustained a tibial shaft fracture were treated with the AO-UTN (Unreamed Tibial Nail). This prospective series included 25 males with a mean age of 28.1 years. These patients were prospectively followed for a mean period of 4.7 years. Clinical and radiographic data was collected. In addition, 20 patients completed an outcomes based questionnaire. In all but one case, the mechanism of injury was a contact with an opposing player. Shin guards provided little prevention against these fractures. The majority of these tibial shaft fractures were consistent with a short oblique or transverse fracture pattern. All fractures were stabilized with the UTN on the day of injury. Four patients had concurrent compartment syndromes and underwent a fasciotomy. Average time until bony consolidation was 11.3 weeks. No patients returned to competitive soccer activities earlier than five months after the initial injury (average 9.5). Only 11 out of 20 soccer players returned to the same level of sporting activity. Six patients never returned to playing soccer again after this injury, even without complications. The fracture of the tibial shaft in soccer players is a severe injury that can be treated safely with the UTN without major complications, but nevertheless only 50% of a mainly-recreational playing population return to the same competitive level as before the injury.