- See:
Stress Frx Menu
- Discussion:
- proximal 1/3 of tibia is most common site for tibial stress frxs in adolescents, but in
runners tibial stress frx
occur near the junction of the middle and distal thirds;
-
diff dx:
-
exertional compartment syndrome
-
shin splints:
- pain is located in posterior mid to distal 1/3 of tibia which is related to periostitis at origin of tibialis posterior;
- exam is notable for local tenderness w/ pain on resisted plantar flexion and inversion;
- fascial hernias;
-
Ewing's sarcoma;
-
osteoid osteoma;
-
prognosis:
- tibial stress frxs may occassionally result in non union even after 4 to 6 months of conservative care;
- it is not unusual for stress fracture to persist for over one year;
-
posteromedial stress frx
- occurs on the compression side of the tibia and has a good prognosis with non operative treatment;
-
anterolateral stress frx:
- occurs on the tension side of the fracture and may be associated with prolonged
non union;
- the prognosis for healing is worse when there are multiple anterior black lines;
- midanterior tibial stress fractures may also require long-term nonoperative treatment;
- Exam:
- point tenderness over an area of induration;
- Radiographs: (
bone scan)
*** 
- Treatment:
- patients require reduction in activity and in some cases require casting;
- external bone stimulator may improve the non operative care of these patients;
- in chronic cases, consider
IM nailing of the tibia fracture;
Stress fractures of the medial tibial plateau.
Stress fractures of the proximal tibia in runners.
Daffner RH, Martinez S, Gehweiler JA Jr, Harrelson JM.
Radiology 1982;142:63-65.
Intramedullary Nailing for Chronic Tibial Stress Fractures. A Review of Five Cases
American Journal of Sports Medicine. Volume 24 No 5 Sep-Oct 1996.
Paul S. Chang MAJ, MC, USA
