EVALUATION OF RETURN TO SPORTS IN JUVENILE FATIGUE FRACTURE-COMPARISON BETWEEN TIBIA AND METATARSAL BONES

Abstract

INTRODUCTION Fatigue fracture typically occurs in young athletes. Among the various of these fractures, the incidence in tibia and metatarsal bones is very high. We investigated treatment, treatment period and activity level in return to sports, concerning fatigue fracture of tibia and metatarsal. METHODS We enrolled 82 cases with 89 fractures in the tibia and 79 cases with 87 fractures in the metatarsal bones. We divided the length of bone into three and classified the areas of fatigue fractures into proximal, central and distal according to X-ray findings. Comparison between tibia and metatarsal bones was performed according to areas of the bone, in cases with plural occurrence, by method of treatment, treatment period and sports activity level at return to sports. RESULTS The areas of fatigue fracture in tibia were 22 fractures (24.7%) in proximal, 30 (33.7%) in central and 37 (41.6%) in distal. Among the 5 metatarsal bones, the third ranked highest with 44 fractures (50.6%) and the second had 24 (27.6%). In the metatarsal bones, 87.1% fractures occurred in central, 12.9% in proximal and none in distal. Without discontinuation of sports, the most usual treatment for tibia was taping and in metatarsal bones orthosis therapy. Treatment periods averaged 12.1 weeks for tibia and 8.5 weeks for metatarsal bones. The treatment period in metatarsal bones was remarkably statistically. In tibia, the fractures at the central averaged 14.6 weeks to heal, which was quite long. Among the 5 metatarsal bones, the second metatarsal bone averaged 6.4 weeks to heal. DISCUSSION In the tibia, the delayed recovery in one third of central area fractures may be attributed to anatomical factors such as poor blood circulation and stress caused by bending. Treatment of metatarsal bones was completed in comparatively short periods. All fractures of metatarsal bones occurred in the proximal and central areas, which are anatomically stable and an arch support is effective for treatment of these fractures.