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Chung JS, Sabatino MJ, Fletcher AL, Ellis HB. Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention. Front Pediatr 2019; 7:397. [PMID: 31637224 PMCID: PMC6787143 DOI: 10.3389/fped.2019.00397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
Case: A 16-year-old African American multi-sport female athlete presents with bilateral worsening activity-related leg pain for 5 months. Multiple bilateral anterior tibial diaphyseal stress fractures and significant vitamin D deficiency were identified. She was treated with a combination of vitamin D supplements and static intramedullary nailing of the bilateral tibias resulting in clinical and radiographic healing and return to sports. Discussion: Vitamin D deficiency and high level of activity in a young athlete may be the etiology to atypical multiple stress fractures. In athletes who may want to return to sport rapidly, early operative intervention and correction of vitamin D deficiency may be treatment options. Level of Evidence: Level V- case report.
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Affiliation(s)
- Jane S Chung
- Texas Scottish Rite Hospital for Children, Dallas, TX, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Meagan J Sabatino
- Texas Scottish Rite Hospital for Children, Dallas, TX, United States
| | - Amanda L Fletcher
- Texas Scottish Rite Hospital for Children, Dallas, TX, United States
| | - Henry Bone Ellis
- Texas Scottish Rite Hospital for Children, Dallas, TX, United States.,University of Texas Southwestern Medical Center, Dallas, TX, United States
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Negative magnetic resonance imaging in three cases of anterior tibial cortex stress fractures. Skeletal Radiol 2017; 46:1775-1782. [PMID: 28921481 DOI: 10.1007/s00256-017-2773-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 02/02/2023]
Abstract
Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Early diagnosis is essential to avoid progression and reduce fracture complications. Imaging plays a key role in confirming the diagnosis. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Two athletes had multiple striations within their tibias. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. We recommend that plain radiographs should be used as the first line investigation when suspecting ATCSFs. Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis.
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Bilateral tibial shaft fractures: a multicenter analysis. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hattori H, Ito T. Recurrent Fracture After Anterior Tension Band Plating With Bilateral Tibial Stress Fracture in a Basketball Player: A Case Report. Orthop J Sports Med 2015; 3:2325967115610069. [PMID: 26535378 PMCID: PMC4622293 DOI: 10.1177/2325967115610069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hiroyuki Hattori
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Tokyo Kamata Medical Center, Ohta-ku, Tokyo, Japan
| | - Toshiyuki Ito
- Department of Orthopedic Surgery, Japan Community Health Care Organization, Tokyo Kamata Medical Center, Ohta-ku, Tokyo, Japan
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Zbeda RM, Sculco PK, Urch EY, Lazaro LE, Borens O, Williams RJ, Lorich DG, Wellman DS, Helfet DL. Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes. Am J Sports Med 2015; 43:1712-8. [PMID: 25828077 DOI: 10.1177/0363546515577355] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures. HYPOTHESIS Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition. RESULTS Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion. CONCLUSION Anterior tension band plating for chronic tibial stress fractures provides a reliable alternative to intramedullary nailing with excellent results. Compression plating avoids the anterior knee pain associated with intramedullary nailing but may result in symptomatic hardware requiring subsequent removal.
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Affiliation(s)
| | | | | | | | | | | | - Dean G Lorich
- Hospital for Special Surgery, New York, New York, USA
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Abstract
INTRODUCTION Adamantinoma is a bone tumor which is commonly showed in mandible. Its occurrence in long bones constitutes a rare affection and a difficult histological diagnosis This rare malignant tumor of mesenchymal and epithelial origin was discovered in the tibia of a male patient. CASE REPORT The authors report a case of adamantinoma of the tibia in a 36- years old. He presented with slowly progressing leg swelling that evolved over 2 years without significant clinical manifestation. Complementary examination and investigation did not help in differential diagnosis and confirmation was only possible after histological examination. There was increase in size of lesion with increased pain and patie3nt presented with pathological fracture. Local extension of the tumor indicated an amputation of leg. The histological exam of the amputation specimen confirmed the results of the initial biopsy by showing cells tumorales in favour of an adamantinoma. After a good medium-term follow up, the patient died secondary to lung metastases. The authors discuss their method of diagnosis and therapeutics in front of such tumor. CONCLUSION Adamantinoma is characterized by a slow clinical development marked by the prevalence of lung metastases and local recurrences. After the diagnosis, there must be a complete and sufficient surgery to avoid a local recurrence or metastasis.
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Affiliation(s)
- Michel N Anoumou
- Department of Traumatology and Orthopaedic surgery, University Hospital of Treichville. Côte d'Ivoire
| | - Maurice Kouameu
- Department of Traumatology and Orthopaedic surgery, University Hospital of Treichville. Côte d'Ivoire
| | - Emmanuel K Koffi
- Department of Anatomy and pathology, University Hospital of Treichville. Côte d'Ivoire
| | - Guy Varango
- Department of Traumatology and Orthopaedic surgery, University Hospital of Treichville. Côte d'Ivoire
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Dailey SK, Archdeacon MT. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report. J Orthop Case Rep 2014; 4:39-43. [PMID: 27298944 PMCID: PMC4722566 DOI: 10.13107/jocr.2250-0685.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Stress fractures are overuse injuries most commonly seen in athletes, military recruits, and individuals with endocrine abnormalities. It has been demonstrated that chronic cases of anterior tibial stress fractures refractory to conservative management respond well to intramedullary nailing. To our knowledge, only one report has been published concerning patients with bilateral tibial stress fractures treated with bilateral intramedullary nailing. All patients in the series were high-level athletes. We present the case of a non-athletic patient with chronic bilateral tibial stress fractures and associated deformity successfully treated with bilateral intramedullary nails. Case Report: A 23-year-old Caucasian female full-time student presented with chronic bilateral shin pain for approximately five years. She had failed an extensive regimen of conservative management. She was diagnosed with chronic bilateral tibial stress fractures based on history, physical examination, and radiologic findings. She subsequently underwent sequential intramedullary nailing of her tibiae. Both tibiae were in valgus alignment; however, this did not preclude nail placement. The nails deformed upon insertion into the sclerotic canals to conform to the deformation. Post operatively the tibiae united and patient was relieved of her symptoms. Conclusion: Bilateral intramedullary nailing of chronic bilateral tibial stress fractures should be considered as a treatment option for all patients, not just high-level athletes, who fail a trial of conservative management. Additionally, mild to moderate tibial malalignment does not necessarily preclude tibial nailing as the smaller nails placed in sclerotic canals will likely deform on insertion and conform to the canal.
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Affiliation(s)
- Steven K Dailey
- Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212
| | - Michael T Archdeacon
- Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212
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Cruz AS, de Hollanda JPB, Duarte A, Hungria Neto JS. Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes. Knee Surg Sports Traumatol Arthrosc 2013; 21:1447-50. [PMID: 23334621 DOI: 10.1007/s00167-013-2365-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. METHODS Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. RESULTS All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. There were no infection, non-union, malunion or anterior knee pain complications. CONCLUSIONS Anterior tibial tension band plating leads to prompt fracture consolidation and is a good alternative for the treatment of anterior tibial cortex stress fractures. Bone grafts were shown to be unnecessary.
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Affiliation(s)
- Alexandre Santa Cruz
- Sports Medicine Division, Department of Orthopedic, Santa Casa de São Paulo, R. Landgraft, 62., São Paulo, SP, 04638-040, Brazil
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Behrens SB, Deren ME, Matson A, Fadale PD, Monchik KO. Stress fractures of the pelvis and legs in athletes: a review. Sports Health 2013; 5:165-74. [PMID: 24427386 PMCID: PMC3658382 DOI: 10.1177/1941738112467423] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time. EVIDENCE ACQUISITION PubMed articles published from 1974 to January 2012. RESULTS Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis. CONCLUSIONS These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports.
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Affiliation(s)
- Steve B. Behrens
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Matthew E. Deren
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Andrew Matson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul D. Fadale
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Keith O. Monchik
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Beck BR, Bergman AG, Miner M, Arendt EA, Klevansky AB, Matheson GO, Norling TL, Marcus R. Tibial stress injury: relationship of radiographic, nuclear medicine bone scanning, MR imaging, and CT Severity grades to clinical severity and time to healing. Radiology 2012; 263:811-8. [PMID: 22623695 DOI: 10.1148/radiol.12102426] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine the relationship between severity grade for radiography, triple-phase technetium 99m nuclear medicine bone scanning, magnetic resonance (MR) imaging, and computed tomography (CT); clinical severity; and recovery time from a tibial stress injury (TSI), as well as to evaluate interassessor grading reliability. MATERIALS AND METHODS This protocol was approved by the Griffith University Human Research Ethics Committee, the Stanford University Panel on Human Subjects in Medical Research, the U.S. Army Human Subjects Research Review Board, and the Australian Defense Human Research Ethics Committee. Informed consent was obtained from all subjects. Forty subjects (17 men, 23 women; mean age, 26.2 years ± 6.9 [standard deviation]) with TSI were enrolled. Subjects were examined acutely with standard anteroposterior and lateral radiography, nuclear medicine scanning, MR imaging, and CT. Each modality was graded by four blinded clinicians. Mixed-effects models were used to examine associations between image severity, clinical severity, and time to healing, with adjustments for image modality and assessor. Grading reliability was evaluated with the Cronbach α coefficient. RESULTS Image assessment reliability was high for all grading systems except radiography, which was moderate (α = 0.565-0.895). Clinical severity was negatively associated with MR imaging severity (P ≤ .001). There was no significant relationship between time to healing and severity score for any imaging modality, although a positive trend existed for MR imaging (P = .07). CONCLUSION TSI clinical severity was negatively related to MR imaging severity. Radiographic, bone scan, and CT severity were not related to time to healing, but there was a positive trend for MR imaging.
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Affiliation(s)
- Belinda R Beck
- School of Physiotherapy and Exercise Science, Centre for Musculoskeletal Research, Griffith University, Gold Coast campus, Griffth, QLD 4222, Australia.
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Bisphosphonate-related femoral periosteal stress reactions: scoring system based on radiographic and MRI findings. AJR Am J Roentgenol 2012; 198:869-77. [PMID: 22451554 DOI: 10.2214/ajr.11.6794] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The purpose of this study was to review the radiographic and MRI findings of bisphosphonate-related femoral periosteal stress reactions to propose a scoring system for predicting symptoms and fracture risk. MATERIALS AND METHODS A retrospective study included patients undergoing long-term bisphosphonate therapy who had radiographic evidence of focal femoral periosteal thickening on radiographs and MR images. There were 43 femoral periosteal stress reactions in 33 patients; eight patients underwent MRI. Radiographs and MR images were evaluated for focal cortical thickening (periosteal and endosteal), bone edema, focal cortical abnormalities (radiolucency, striations, cavities), and dreaded black line. The radiographic score (derived with statistical methods) and simple scores (simple radiographic, MRI, and combined scores) were compared with symptoms and fracture outcome. RESULTS Logistic regression analysis showed an association between radiographic dreaded black line and symptoms (odds ratio, 68.0). Kaplan-Meier and Cox regression analyses showed radiographic dreaded black line (p < 0.0005; hazard ratio, 27.3) and focal cortical radiolucency (p = 0.011; hazard ratio, 6.8) were independent predictors of fracture. The survival score derived from Cox regression coefficients showed good separation of high- and low-risk groups. Mann-Whitney tests showed an association between MRI and combined scores and symptoms (p = 0.036, p = 0.036). The area under the receiver operating characteristic curve suggested better association with symptoms for MRI and combined scores than for simple radiographic scores (1.00, 1.00, 0.93). CONCLUSION In bisphosphonate-related femoral periosteal stress reactions, radiographic dreaded black line and MRI and combined scores were associated with symptoms, and radiographic survival score was predictive of fracture risk. The relation between MRI and combined scores and fracture was not statistically significant.
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YAMADA TOMO, KAHANOV LEAMOR. Complications of Intramedullary Rodding for Chronic Tibial Stress Fractures inFemale Athletes: Three Case Reports. Res Sports Med 2010. [DOI: 10.1080/15438620490280558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Beck BR, Matheson GO, Bergman G, Norling T, Fredericson M, Hoffman AR, Marcus R. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am J Sports Med 2008; 36:545-53. [PMID: 18055921 DOI: 10.1177/0363546507310076] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial stress fractures increasingly affect athletes and military recruits, with few known effective management options. Electrical stimulation enhances regular fracture healing, but the effect on stress fractures has not been definitively tested. HYPOTHESIS Capacitively coupled electric field stimulation will accelerate tibial stress fracture healing. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Twenty men and 24 women with acute posteromedial tibial stress fractures were referred from local clinicians. Subjects were randomly assigned active or placebo capacitively coupled electric field stimulation to be applied for 15 hours per day until healed, given supplemental calcium, and instructed to rest from provocative training. Healing was confirmed when hopping to 10 cm for 30 seconds could be achieved without pain. RESULTS No difference in time to healing was detected between treatment and placebo groups. Women in the treatment group healed more slowly than did the men (P = .05). Superior treatment compliance was associated with reduced time to healing (P = .003). Rest noncompliance was associated with increased time to healing (P = .05). CONCLUSION Whole-group analysis did not detect an effect of capacitively coupled electric field stimulation on tibial stress fracture healing; however, greater device use and less weightbearing loading enhanced the effectiveness of the active device. More severe stress fractures healed more quickly with capacitively coupled electric field stimulation. CLINICAL RELEVANCE Although the use of capacitively coupled electric field stimulation for tibial stress fracture healing may not be efficacious for all, it may be indicated for the more severely injured or elite athlete/recruit whose incentive to return to activity may motivate superior compliance.
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Abstract
A stress fracture is a partial or complete bone fracture that results from repeated application of stress lower than the stress required to fracture the bone in a single loading. Otherwise healthy athletes, especially runners, sustain stress injuries or fractures. Prevention or early intervention is the preferable treatment. However, it is difficult to predict injury because runners vary with regard to biomechanical predisposition, training methods, and other factors such as diet, muscle strength, and flexibility. Stress fractures account for 0.7% to 20% of all sports medicine clinic injuries. Track-and-field athletes have the highest incidence of stress fractures compared with other athletes. Stress fractures of the tibia, metatarsals, and fibula are the most frequently reported sites. The sites of stress fractures vary from sport to sport (eg, among track athletes, stress fractures of the navicular, tibia, and metatarsal are common; in distance runners, it is the tibia and fibula; in dancers, the metatarsals). In the military, the calcaneus and metatarsals were the most commonly cited injuries, especially in new recruits, owing to the sudden increase in running and marching without adequate preparation. However, newer studies from the military show the incidence and distribution of stress fractures to be similar to those found in sports clinics. Fractures of the upper extremities are relatively rare, although most studies have focused only on lower-extremity injuries. The ulna is the upper-extremity bone injured most frequently. Imaging plays a key role in the diagnosis and management of stress injuries. Plain radiography is useful when positive, but generally has low sensitivity. Radionuclide bone scanning is highly sensitive, but lacks specificity and the ability to directly visualize fracture lines. In this article, we focus on magnetic resonance imaging, which provides highly sensitive and specific evaluation for bone marrow edema, periosteal reaction as well as detection of subtle fracture lines.
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Affiliation(s)
- Michael Fredericson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5336, USA.
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Mid-Anterior Tibial Stress Fracture in a Female Elite Athlete. Eur J Trauma Emerg Surg 2007; 33:96-8. [DOI: 10.1007/s00068-007-6068-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 08/17/2006] [Indexed: 10/23/2022]
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López Lanza J, Pérez Martín Á, López Videras R. Fractura tibial bilateral por fatiga en mujer no deportista: a proposito de un caso. Semergen 2006. [DOI: 10.1016/s1138-3593(06)73334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Peris P, Monegal A, Martínez M, Guañabens N. Bilateral tibial stress fracture presenting as painful edemas in lower limbs. Joint Bone Spine 2006; 73:557-9. [PMID: 16904927 DOI: 10.1016/j.jbspin.2005.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Accepted: 11/04/2005] [Indexed: 11/27/2022]
Abstract
Bilateral stress fracture of the tibia is infrequent. This paper presents an unusual case of a 73-year-old man who sustained a bilateral stress fracture of the tibia presenting as painful edemas in lower limbs. The radiographic and scintigraphic examination confirmed the diagnosis of the fractures. In addition, the patient was receiving androgen deprivation therapy with GnRH analogs for the treatment of prostate cancer and the bone density measurements confirmed the presence of osteoporosis. Treatment with restricted weight bearing was associated with improvement of clinical symptoms. Early recognition and diagnosis of this injury is essential for treating the underlying osteoporosis as well as the fracture.
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Affiliation(s)
- Pilar Peris
- Service of Rheumatology, Hospital Clínic Barcelona, Villarroel 170, 08036 Barcelona, Spain
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Borens O, Sen MK, Huang RC, Richmond J, Kloen P, Jupiter JB, Helfet DL. Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes: a report of 4 cases. J Orthop Trauma 2006; 20:425-30. [PMID: 16825970 DOI: 10.1097/00005131-200607000-00011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We hypothesize that anterior plating is a biomechanically sound approach to treatment of these fractures, and will lead to an earlier return to full activity than either nonoperative treatment or intramedullary nailing. We present a retrospective series of 4 case reports of 4 world-class female athletes with stress fractures of the anterior tibial cortex treated by anterior plating between 2001 and 2004. Average follow-up was 15 months (range 12 to 48 mo). Anterior tension band plating resulted in fracture healing in all 4 cases and return to full activity at a mean of 10 weeks. All patients returned to preinjury competitive levels. There were no complications of infection, nonunion, or malunion. Anterior tension-band plating of an anterior tibial stress fracture leads to rapid fracture healing and return to competition for high-performance female athletes. This approach should be considered in those athletes who wish to avoid the more prolonged convalescence associated with nonoperative treatment, or the problems, especially of the knee, associated with intramedullary nailing.
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Affiliation(s)
- Olivier Borens
- Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Abstract
Tibial stress fractures are relatively common overuse injuries that can often be difficult to treat. Other comorbid medical conditions, including the female athlete triad, need to be carefully evaluated and treated. Nonoperative treatment is the standard, but surgical intervention may be necessary. Intramedullary nailing may allow return to sport but does not guarantee healing.
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Affiliation(s)
- Andrea J Young
- Pacific Sports Medicine at MultiCare, Tacoma, WA 98405-1616, USA.
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21
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Varner KE, Younas SA, Lintner DM, Marymont JV. Chronic anterior midtibial stress fractures in athletes treated with reamed intramedullary nailing. Am J Sports Med 2005; 33:1071-6. [PMID: 15888719 DOI: 10.1177/0363546504271968] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A chronic anterior midtibial stress fracture is a serious, difficult-to-treat injury that can adversely affect an athlete's career. HYPOTHESIS The use of a reamed intramedullary nail for a chronic anterior tibial stress fracture is a safe and effective treatment for an athlete. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seven collegiate-level athletes with 11 chronic anterior midtibial stress fractures were treated with reamed intramedullary nailing between 1997 and 2000. These patients were followed for a mean duration of 17 months. RESULTS The mean age of the patients at the time of stress fracture diagnosis was 17 years. Seven of the fractures occurred in male athletes, whereas 4 occurred in female athletes. All patients had failed nonoperative treatment, including rest, activity modification, use of an orthosis, and low-intensity ultrasound stimulation, for a minimum of 4 months. Patients had experienced symptoms for a mean duration of 12 months. Clinical and radiological union occurred at a mean of 2.7 and 3 months, respectively. The mean duration for return to sports after surgery was 4 months. At last follow-up, all patients had full range of motion at the knee and ankle joints and were satisfied with the results. One patient developed bursitis at the tibial nail insertion site that was resolved with a steroid injection. Another patient sustained a traumatic fracture of the distal tibia 1 year after intramedullary nailing of the tibial stress fracture. This fracture healed with nonoperative treatment. No other complications were observed. CONCLUSION Intramedullary nailing of the tibia for chronic stress fracture has a high union rate, allows for a low complication rate, and allows for an early return to competitive sports. This procedure is an excellent alternative treatment for those fractures that have failed nonsurgical treatment.
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Affiliation(s)
- Kevin E Varner
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
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Affiliation(s)
- Santos F Martinez
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, Tennessee 38104, USA
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Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic Tibial Stress Reactions: MRI Detection and Clinical Follow-Up in Distance Runners. AJR Am J Roentgenol 2004; 183:635-8. [PMID: 15333349 DOI: 10.2214/ajr.183.3.1830635] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was twofold: to determine if asymptomatic elite distance runners exhibit stress reactions of the tibia on MR images and to determine if the presence of bone stress lesions predicts later development of symptomatic tibial stress injuries. CONCLUSION Signs of a tibial stress reaction were found on MRI in 43% of the 21 asymptomatic college distance runners in this study. The presence of these changes was not found to be a predictor of future tibial stress reactions or stress fractures. Our findings underscore the importance of correlating MRI findings with clinical findings before making therapeutic decisions.
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Affiliation(s)
- A Gabrielle Bergman
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305-5105, USA
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Yildirim M, Gursoy R, Varoglu E, Oztasyonar Y, Cogalgil S. 99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players. Br J Sports Med 2004; 38:15-8. [PMID: 14751939 PMCID: PMC1724727 DOI: 10.1136/bjsm.2002.000695] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate stress fractures in leg (particularly around the knee, tibia, and femur) and knee pathology in active asymptomatic (no symptoms in the preceding month) soccer players. METHOD The study included 42 asymptomatic soccer players (21 women, 21 men; age range 19-31 years). Players from seven teams in the major female professional and amateur male soccer leagues were examined by technetium-99m-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy during the soccer season. Four hours after intravenous injection of 20 mCi (99m)Tc-MDP, standard imaging included anterior planar spot images of the legs, lateral images of the knee, and single photon emission computed tomography (SPECT). RESULTS Although the players were asymptomatic, increased tracer uptake, indicating stress fracture, was found in 28 (66%). Most of the stress fractures were in the tibia (62%) and femur (5%). In the 42 subjects (84 legs), 35 sites (42%) showed rupture of the posterior horn of the lateral meniscus and bone bruising of the tibial plateau, 16 sites (19%) showed rupture of the anterior horn of the medial meniscus, 11 sites (13%) showed bone bruising of the lateral femoral condyle, eight sites (10%) showed bone bruising of the medial femoral condyle, and there was avulsion injury to the infrapatellar tendon insertion in the anterior tibia in 34 sites (40%). There were 11 anterior cruciate ligament injuries. CONCLUSION Bone SPECT is very accurate, easy to perform, cost effective, may give valuable information before magnetic resonance imaging studies in the detection of meniscal tears, and may be used successfully when magnetic resonance imaging is unavailable.
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Affiliation(s)
- M Yildirim
- Department of Nuclear Medicine, Medical Faculty, Ataturk University, 25240-Erzurum, Turkey.
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Affiliation(s)
- Samir G Tejwani
- Department of Orthopedic Surgery, University of California Los Angeles, David Geffen School of Medicine, 90095-6902, USA
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26
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Affiliation(s)
- Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle 98195-4410, USA.
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Gardiner JR, Isbell WM, Johnson DL. Bilateral anterior tibial stress fractures treated with dynamic intramedullary nailing. Orthopedics 2003; 26:720-2; discussion 722. [PMID: 12875569 DOI: 10.3928/0147-7447-20030701-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- James R Gardiner
- University of Kentucky, Division of Sports Medicine, Lexington, Ky 40536, USA
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