Return to sports after stress fractures of the tibial diaphysis: a systematic review

Robertson, Gregory Aidan James; Wood, Alexander

doi:10.1093/bmb/ldv006

Cited by 40 publications

(53 citation statements)

References 36 publications

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“…Common in running athletes, anterior tibial diaphyseal stress fractures (TDSFs) are visualised on radiographs as the “dreaded black line” on the anterior mid tibial cortex[1,2,14,24]. However, radiographic changes can be absent in up to 85% of cases[25]; with persisting symptoms and negative radiographs, the recommended second line imaging investigation is now magnetic resonance imaging (MRI) scan[24].…”

Section: High Risk Sport-related Lower Limb Stress Fracturesmentioning

confidence: 99%

“…A higher grade of Fredericson Scale has been shown to be associated with an increased return to running time for TDSFs[16]. When both cortices of the tibia are involved, with completed fracture lines, this injury needs to be managed as an acute fracture[1,2,14]. …”

Section: High Risk Sport-related Lower Limb Stress Fracturesmentioning

confidence: 99%

“…Current treatment protocols advocate a trial of 3 to 6 mo of conservative management, as initial treatment of these injuries[1,2,14]. Fredericson Grade 1 to 3 injuries are managed with crutch-assisted weightbearing until resolution of pain; bracing serves as a potential adjunct to reduce symptoms[16].…”

Section: High Risk Sport-related Lower Limb Stress Fracturesmentioning

confidence: 99%

“…Following such injuries, return times to sport are often prolonged, and failure to return to sport, chance of re-injury and persisting morbidity are all distinct possibilities[2-8]. As a group, stress fractures comprise just over 10% of all sport-related injuries, with this figure as high as 30% within certain sports, such as running[1,9-12].…”

Section: Introductionmentioning

confidence: 99%

“…The significance of this injury depends on the location and nature of the fracture[1]: The tibial diaphysis is the commonest reported location and comprises up to three quarters of all stress fractures[2]; other common sites include the metatarsals, the femoral neck, the tarsal naviculus, the fibula, the medial malleolus and the calcaneus[1,14,15]. Until the 1980’s, much of the stress fracture research had focussed on military cohorts, overlooking cohorts of sporting individuals[9,10].…”

Section: Introductionmentioning

confidence: 99%

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Lower limb stress fractures in sport: Optimising their management and outcome

Robertson¹,

Wood²

2017

WJO

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Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting.

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