Nonunions of stress fractures of the tibia

Abstract

Stress fractures of the tibia commonly occur in the proximal metaphysis and heal readily with rest. Fractures of the middle third of the tibia, on the other hand, are uncommon. We encountered six stress fractures of the middle third of the tibia over a 5 year period. None of these fractures healed with simple immobilization. One was treated with electromagnetic stimulation and failed to unite 2 years after presentation. One patient underwent a biopsy of the lesion without bone grafting and it had not healed when he was last seen. One patient sustained two acute complete fractures, and the stress fracture finally healed after the second acute fracture was openly reduced and internally fixed. The other three lesions were excised and grafted because of failure to unite. They all healed promptly. Stress fractures of the middle third of the tibia are unusual lesions. However, care must be taken in treating them. The patient must protect the extremity until the fracture has completely healed. Surgical excision and bone grafting of the lesion may be required if the fracture does not heal with plaster immobilization.

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

“…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. Similar results were reported by Green et al [25]. These reports suggest that although surgical intervention may become necessary, conservative measures may still be successful and should be considered but not in high demand professional athletes.…”

Intramedullary Nailing for Chronic Tibial Stress Fractures

“…The radiographic studies were nearly identical in each patient and are consistent with a nonunion or focal infarct of a chronic stress fracture previously described in the literature. 1,7,9,14,17,19 Although a great deal of data have been recorded on stress fractures since they were first described in 1855 by Briethaupt,5 the exact cause of these fractures remains unknown. They usually resolve with nonoperative treatment, activity modification, and correction of biomechanical abnormalities.…”

“…There is relatively little discussion of these specific injuries in the literature, but they are often associated with dancers and athletes involved in repetitive running and jumping activities. 1,7,9,12,17,19 Midanterior tibial stress fractures are probably caused by a combination of factors. The anatomy of the anteromedial tibia provides limited musculotendinous support and blood supply, which are necessary for favorable healing.…”

“…Point tenderness at the midanterior tibia should alert the clinician to the potential of a more problematic subset of tibial stress fractures. 1,7,9,19 Physical examination, with attention to the patient's fitness level, helps determine whether the injury is a result of overuse (an athlete increasing his or her level of performance) or an overloading injury (a poorly conditioned new military trainee with poor muscular development).…”

Stress Fracture / Stress Reaction of the Lower Leg and Foot

“…Intramedullary nailing of the tibia has been reported as having a high union rate and a low complication rate, and provides an early return to competitive sports (average of 4 months) in those who have failed conservative management (Varner et al 2005). Tibial drilling (Orava and Hulkko 1988), bone grafting and internal fixation (Green et al 1985) have also been described. One more recent study compared antero-medial and lateral tibial drilling with laminofixation in 45 athletes, mainly runners (Liimatainen et al 2009).…”