Identification of a High-Risk Anterior Tibial Stress Fracture

Abstract

The patient was a deployed 34-year-old female soldier with a chief complaint of bilateral anterior shin pain for the past 8 weeks. Due to concern for a stress fracture, radiographic views of the bilateral tibia and fibula were completed, which revealed cortical thickening through the anterior midtibial regions bilaterally, consistent with stress reactive changes. Furthermore, a transverse lucency through the anterior cortex of the anterior right midtibial region was noted, which was consistent with a stress fracture. The patient was immediately placed in a short leg cast and was given strict non—weight-bearing instructions for gait. She was subsequently evacuated to her home duty station for consultation with an orthopaedic surgeon to determine if surgical intervention was warranted. This report illustrates the importance of identifying stress fractures considered to be high risk. J Orthop Sports Phys Ther 2010;40(12):833. doi:10.2519/jospt.2010.0420

Estimation of return-to-sports-time for athletes with stress fracture – an approach combining risk level of fracture site with severity based on imaging

“…For example, the tibia, a frequent and well-examined stress fracture site, contains multiple high-risk sites (anterior midshaft or medial malleolus = high-risk, posteromedial aspect = low-risk) [5,6,19,20]. Recent case reports and publications therefore emphasize the need to differentiate between high- and low-risk sites for treatment and estimation of RTST [10,11,21]. …”

Diagnostic Imaging for Distal Extremity Injuries in Direct Access Physical Therapy: An Observational Study

“…Numerous case reports from a direct-access sports physical therapy clinic have been published that highlight the ability of physical therapists to appropriately recognize and disposition patients with foot/ankle and wrist/hand fractures. [20][21][22][23][24][25][26][27][28][29][30] Among non-military physical therapists who are not currently able to refer patients directly to a radiologist, 55 to 95% reported routinely performing the nine fundamental skills in their clinical practice that are necessary to utilize diagnostic imaging effectively. 31 The Ottawa Ankle Rules are a valid screening tool for foot/ankle fractures, 32,33 but have not been studied in a physical therapy direct-access setting.…”