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Stress Fractures of the Tibia

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Stress Fractures in Athletes

Abstract

The anatomy and biomechanics of the tibia play a critical role in the development and management of tibial stress fractures. Posterior calf musculature and the relative anterior tibial avascularity lead to a high rate of nonunion, delayed union, and fracture in “high-risk” tension-sided anterior tibial cortex stress fractures. Fracture location at the compressive side of the tibia and the abundant vasculature are favorable characteristics in “low-risk” posteromedial tibial stress fractures. The differential diagnosis of patients with overuse injuries of the leg includes stress fracture, medial tibial stress syndrome, exertional compartment syndrome, popliteal artery entrapment syndrome, and multiple nerve entrapment syndromes, among others. Risk factors for 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, and inadequate caloric intake. The history and physical examination of a patient with a tibial stress fracture generally indicates focal point tenderness at the site of the fracture, unremitting pain with weight-bearing activity, and pain with hop and tuning fork testing. Magnetic resonance imaging is the imaging modality with the best diagnostic sensitivity and specificity. Non-operative treatment is generally successful in low-risk posteromedial tibial stress fractures. Surgical treatment, including reamed intramedullary rodding and anterior tension-band plating, is a successful treatment for chronic anterior mid-diaphyseal tibial fractures that have failed nonsurgical treatment. These procedures have produced high union rates, low complication rates, and early return to sport.

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Disclosures

J.D.H.: Editorial Board for Arthroscopy: The Journal of Arthroscopic and Related Surgery.

K.E.V.: None.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower, Suite 2500, Houston, TX, 77030, USA

    Joshua D. Harris MD & Kevin E. Varner MD

Authors
  1. Joshua D. Harris MD
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  2. Kevin E. Varner MD
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Correspondence to Joshua D. Harris MD .

Editor information

Editors and Affiliations

  1. Assistant Professor, Department of Orthopedics, Team Physician, Department of Athletics, Physician Lead, Endurance Medicine, Sports Medicine Center, The Ohio State University, Columbus, Ohio, USA

    Timothy L. Miller

  2. Judson Wilson Professor, Department of Orthopedics, Head Team Physician, Department of Athletics, Executive Director, Sports Medicine Center, The Ohio State University, Columbus, Ohio, USA

    Christopher C. Kaeding

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© 2015 Springer International Publishing Switzerland

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Harris, J.D., Varner, K.E. (2015). Stress Fractures of the Tibia. In: Miller, T., Kaeding, C. (eds) Stress Fractures in Athletes. Springer, Cham. https://doi.org/10.1007/978-3-319-09238-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-09238-6_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09237-9

  • Online ISBN: 978-3-319-09238-6

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