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Stress Fractures of the Tibia

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Stress Fractures in Athletes

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Abstract

The tibia is the most common site for developing a stress fracture. Tensile forces created by the gastrocnemius and soleus musculature and relative hypovascularity lead to a high rate of nonunion, delayed union, and stress fracture at the anterior tibial cortex. Stress fractures occur more commonly at the posterior medial cortex of the tibial diaphysis but heal more readily due to compressive forces at that area. Risk factors for a tibial stress fracture include prior stress fracture, recent increases in training intensity and/or duration, improper training technique or equipment, the female athlete triad, calcium and vitamin D deficiency, low body mass index, and inadequate caloric intake. Athletes with stress fractures present with point tenderness at the site of the injury along with pain with single leg stance, hop test, and fulcrum test. Radiographs are the initial evaluation tool for stress fractures, though they are commonly negative unless the injury is chronic or severe. Magnetic resonance imaging has shown to be highly sensitive and specific for stress fractures and the most predictive of time away from sport. Relative rest from the causative activity with proper nutritional and biomechanical support is recommended for low-grade stress injuries of the posteromedial tibia. Surgical stabilization with a reamed intramedullary rod or anterior lateral tension-band plate has shown success in treating a chronic anterior cortex tibial stress fracture known as the “dreaded black line.” These procedures have produced high union rates, low complication rates, and early return to sport, though hardware irritation is common.

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Authors and Affiliations

  1. Houston Methodist Hospital, Department of Orthopedics and Sports Medicine, Houston, TX, USA

    Joshua D. Harris & Kevin E. Varner

  2. Weill Cornell College of Medicine, New York, NY, USA

    Joshua D. Harris

  3. Houston Ballet, Houston Texans, Houston Dynamo, University of Houston, Houston, TX, USA

    Kevin E. Varner

  4. Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, Columbus, OH, USA

    Timothy L. Miller

  5. Ohio State University Athletics, The Ohio State University Wexner Medical Center Endurance Medicine Team, Columbus, OH, USA

    Timothy L. Miller

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  1. Joshua D. Harris
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  2. Kevin E. Varner
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  3. Timothy L. Miller
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Correspondence to Timothy L. Miller .

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Editors and Affiliations

  1. Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical, Columbus, OH, USA

    Timothy L. Miller

  2. Jameson Crane Sports Medicine Institute, The Ohio State University Wexner Medical, Columbus, OH, USA

    Christopher C. Kaeding

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Harris, J.D., Varner, K.E., Miller, T.L. (2020). Stress Fractures of the Tibia. In: Miller, T.L., Kaeding, C.C. (eds) Stress Fractures in Athletes. Springer, Cham. https://doi.org/10.1007/978-3-030-46919-1_17

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  • DOI: https://doi.org/10.1007/978-3-030-46919-1_17

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