ANTERIOR TIBIAL STRESS FRACTURE-TRACK

Abstract

HISTORY: A 15-year-old male state champion track hurdler presented to the Sports Medicine clinic with the complaint of left shin pain. He has had pain along his left shin for approximately five months during the recent track season. He noticed a significant worsening two days ago while running the 400-meter hurdles. He states that while making the final turn he went from feeling good to one step later having severe pain in his left shin. He denies any recent trauma to the left leg, other joint pains, numbness, tingling, fever, chills, or weight loss. PHYSICAL EXAMINATION: General: Well-developed, well appearing male. Musculoskeletal: Normal gait with obvious severe genu valgum and bilateral pes planus. He has tenderness to palpation along the anterior portion of the left tibia approximately 17cm proximal to the medial malleolus. There is full range of motion at the hip, knee, and ankle. His muscle strength in the lower extremities is 5+/5. He is neurovascularly intact with no obvious focal deficits. ANTERIOR TIBIAL STRESS FRACTURE-TRACK: J.M. Buchanan, S.M. Simons, FACSM, Sports Medicine Institute, South Bend, IN, USA DIFFERENTIAL DIAGNOSIS: Anterior tibial stress fracture Medial tibial stress syndrome Exercise induced compartment syndrome Neoplasm TESTS AND RESULTS: Bilateral anterior-posterior and lateral tibia and fibula radiographs: Left anterior tibia stress fracture with a dreaded black line. MRI of the tibia and fibula: Bone marrow and cortical edema noted in left tibia on T2 weighted images. Repeat anterior-posterior and lateral radiographs of the left tibia and fibula: healing anterior tibia stress fracture FINAL/WORKING DIAGNOSIS: Anterior stress fracture of the left tibia TREATMENT AND OUTCOMES: Placement of electronic bone stimulator. Restriction from all running and stressful activities while substituting non-weightbearing exercises until radiographs reveal healing. Provide patient with customized shoe orthotics for upcoming track season. Patient was followed every 6 weeks with plain radiographs which revealed gradual resolution of the tibial stress fracture. Patient has returned to full participation in track/hurdles with conservative management alone eliminating the need for operative intramedullary rod placement.