Tibiofibular synostosis stress fracture: a case report

Surgical Treatment of a Symptomatic Diaphyseal Tibiofibular Synostosis in a Professional Rugby Player: A Case Report and Literature Review

CONTEXT

Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature.

CASE PRESENTATION

A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least.

CONCLUSION

In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes' recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity.

Stress fractures of the foot and ankle

Stress fractures occur as a result of microscopic injuries sustained when bone is subjected to repeated submaximal stresses. Overtime, with repeated cycles of loading, accumulation of such injuries can lead to macro-structural failure and frank fracture. There are numerous stress fractures about the foot and ankle of which a trauma and orthopaedic surgeon should be aware. These include: metatarsal, tibia, calcaneus, navicular, fibula, talus, medial malleolus, sesamoid, cuneiform and cuboid. Awareness of these fractures is important as the diagnosis is frequently missed and appropriate treatment delayed. Late identification can be associated with protracted pain and disability, and may predispose to non-union and therefore necessitate operative intervention. This article outlines the epidemiology and risk factors, aetiology, presentation and management of the range of stress fractures in the foot and ankle.

Diaphyseal tibiofibular synostosis in professional athletes: Report of 2 cases

Anterior leg pain is common in professional athletes and tibiofibular synostosis is reported to be a rare cause of anterior compartment pain or ankle pain related to sports activities. The management and appropriate treatment of this condition in professional athletes is controversial and the literature on the topic is sparse. Distal synostosis is usually related to ankle sprain and syndesmotic ligament injury, and proximal synostosis has been linked to leg length discrepancy and exostosis. Mid-shaft synostosis is even less common than proximal and distal forms. We present the treatment of mid-shaft tibiofibular synostosis in 2 cases of professional athletes (soccer and basketball player), along with a review of the literature. When diaphyseal synostosis is diagnosed, first-line conservative treatment, including ultrasound-guided steroid injection is recommended. However, if it does not respond to conservative management, surgical resection may be indicated to relieve symptoms.

Diaphyseal tibiofibular synostosis in a runner

Diaphyseal tibiofibular synostosis is a very rare cause of shin and ankle pain. A 35-year-old male presented with complaints of left shin and ankle pain of 3 years duration that was sometimes worse after running a few miles. One year before presenting to our hospital, the actual cause for his pain was missed when only lumbar radiographs were taken at another institution. A full-length tibia film revealed a diaphyseal tibiofibular synostosis at our hospital. The presence of a synostosis should alert the surgeon to search for the various abnormalities usually associated with this condition. Magnetic resonance imaging and enhanced 3-dimensional computed tomography are essential to rule out the possibility of a neoplastic process and to determine its relation to the neurovascular structures. Simple excision of the synostosis can provide excellent symptomatic relief with a minimal risk of complications.