tibial sports injury

Question 1

What is a tibial stress fx?

Answer 1

• An overuse injury where normal or abnormal bone is subjected to repetitive stress-> microfx
• common in runners/military recruits
• change in training routine
• mechanism
  
  • linear microfx in trabecullar bone from repitive loading
• Pathophysiology
  
  • callus formation, woven bone, endochondral bone formation

Question 2

What are the symptoms and radiographic findings of tibial stress fx?

Answer 2

• Pain worse with activity
• Pain direct over fx site

Xray

• Lateral xray- show ‘dreaded black line’ anteriorly = tension fx from posterior muscle force
• endosteal thickening
• periosteal thickening
• periosteal rxn with cortical thickening

MRI

• Replacing bone scan for dx and most sensitive finding
• marrow odema seen on T2 weighted images

Question 3

What is the tx of tibial stress fx?

Answer 3

Non operative

• activity restriction with protected with bearing 4-6 wks
  
  • most cases
  • avoid Nsaids - slows bone healing
  • consider bone stimulator

Operative

• Intramedullary tibial nailing
  
  • if dreaded black line is present, especially if violates the anterior cortex
  • fx of anterior cortex of tibia have highest likelihood of delayed healing or non union