Intramedullary Nailing for Chronic Tibial Stress Fractures

Abstract

Chronic tibial stress fracture is an unusual condition that is primarily seen in athletes and military personnel. Recurrent or recalcitrant stress fractures can be career-ending because they require lengthy nonoperative treatment. We performed a retrospective review of five patients who underwent intramedullary tibial nailing for recalcitrant stress fractures at Womack Army Medical Center, Ft. Bragg, North Carolina, from 1991 to 1994. Interviews were used to survey the patient's history and outcome. We reviewed each case regarding preoperative symptoms, preoperative treatment, surgery performed, radiographic findings, and functional outcome. In each case there were several similarities in symptoms and, most notably, radiographic findings and failure of nonoperative therapy for more than 1 year. Each patient had an unusually narrow medullary canal, a thickened anterior cortex, and a linear unicortical fracture line on the anterior or tension side. Although functional results varied, all patients reported improvement in their symptoms and could return to limited running. There were two excellent results (defined as unlimited pain-free running and resolved tibial pain) and three good results. We believe intramedullary tibial nailing should be considered for treating chronic stress fractures of the midanterior tibia that are recalcitrant to nonoperative therapy in a selected group of patients.

Multiple Tibial Insufficiency Fractures in the Same Tibia

“…But with continued stress, periosteal reaction and cortical thickening develop at the site of injury, which makes the fracture visible on a standard radiograph over time. 1,13,15 A 3-phase technetium 99m bone scan is a useful technique for diagnosis. This technique is sensitive to diagnose osseous pathology at an early stage.…”

“…1 Infection and tumors, such as osteogenic sarcoma, Ewing's sarcoma, and osteoid osteoma, as well as metastasis, should also be considered.…”

“…1,16 Midanterior tibial stress fractures are particularly difficult to treat and frequently require a long period of closed treatment.…”

Anterior Tibial Cortex Stress Fracture in a High Demand Professional Soccer Player

“…Batt and coworkers [23] reported successful healing in all three patients in a mean of 8 months with the use of a pneumatic leg brace. On the other hand Chang and Harris [24] reported good to excellent results in fi ve patients that were treated with reamed unlocked tibial nails. Blank [5], in a study of fi ve patients reported that none of the fractures healed despite immobilization in a cast for three to fi ve months.…”

Mid-Anterior Tibial Stress Fracture in a Female Elite Athlete

“…Most cases will resolve within 6 weeks. Treatment of stage III or IV requires operative treatment [14][15][16]. Also, stress fracture non-unions or chronic stress fractures of the mid-anterior tibia are recalcitrant to non-operative therapy [8,9,12].…”