Stress fracture of the tibia in athletes: diagnosis and natural course

Johansson, Claes; Ekenman, Ingrid; Lewander, R.

doi:10.1111/j.1600-0838.1992.tb00326.x

Cited by 29 publications

(28 citation statements)

References 14 publications

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“…Orava et al 39 found a time to return to sport of 24 weeks (range 12–40) for the healed fractures but the non-unions returned to sport 28.4 weeks (16–64) after subsequent surgery. In total, 13/14 (93%)15 and 9/17 (53%)39 anterior tibial stress fractures did not unite after initial conservative treatment. Of these patients, 13 needed secondary surgery consisting of transverse drilling and excision of the granulated tissue and in some cases autologous bone graft was added.…”

Section: Resultsmentioning

confidence: 91%

“…After a delay from onset of symptoms until treatment of up to 36 months, all patients were initially treated with rest from sports and/or immobilisation (method unspecified). Johansson et al 15 reported a return to sport rate of 55%. Orava et al 39 found a time to return to sport of 24 weeks (range 12–40) for the healed fractures but the non-unions returned to sport 28.4 weeks (16–64) after subsequent surgery.…”

Section: Resultsmentioning

confidence: 97%

“…In addition, risk of detection bias was high when there was no blinding of the outcome assessor6 19 33–36 or unclear when blinding was not reported 15 20 21 37–41. Some studies were clear and complete in their data reporting, resulting in a low risk to attrition and reporting bias.…”

Section: Resultsmentioning

confidence: 99%

“…Two small retrospective case series (n=14 and 17) were included, resulting in very low-quality evidence 15 39. Patients were all recreational or elite level athletes, aged between 11–44 years old.…”

Section: Resultsmentioning

confidence: 99%

“…Compression of the fracture site is therefore hindered. From start of treatment until complete healing can take up to 20 months 15 16. Owing to its location and low prevalence, symptoms are usually not recognised as stress fracture.…”

Section: Introductionmentioning

confidence: 99%

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Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

et al. 2014

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AimTo compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal.MethodsSystematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective studies. Two reviewers independently extracted data and assessed methodological quality. Main outcomes were return to sport and complication rate.Results18 studies were included (2 anterior tibia (N=31), 8 navicular (N=200) and 8 fifth metatarsal (N=246)). For anterior tibial fracture, no studies on initial surgery were eligible. Conservative treatment resulted in high complication rates and few cases returned to sport. For navicular fracture, a weighted mean return to sport of 22 for conservative and 16 weeks for surgical treatment was found. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Surgical procedures varied widely. For the fifth metatarsal fracture, weighted mean return to sport was 19 for conservative and 14 weeks for surgical treatment. Surgery consisted of intramedullary screw fixation or tension band wiring. For conservative methods, insufficient details were reported. Overall, there was a high risk of bias; sample sizes were small and GRADE level of evidence was low.ConclusionsStrong conclusions for surgical or conservative therapy for these high-risk stress fractures cannot be drawn; quality of evidence is low and subjected to a high risk of bias. However, there are unsatisfying outcomes of conservative therapy in the anterior tibia. The role of initial surgery is unknown. For the navicular, surgery provided an earlier return to sport; and when treated conservatively, weightbearing should be avoided. For the fifth metatarsal, surgery provided the best results. Treatment decision-making would greatly benefit from further prospective research.Study registration numberPROSPERO database of systematic reviews: CRD42013004201.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 97%