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This Article Full Text Full Text (PDF) All Versions of this Article: 33/7/1071    most recent 0363546504271968v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Varner, K. E. Articles by Marymont, J. V. Search for Related Content PubMed PubMed Citation Articles by Varner, K. E. Articles by Marymont, J. V. Related Collections Fracture Operative

Chronic Anterior Midtibial Stress Fractures in Athletes Treated With Reamed Intramedullary Nailing

From the Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, and the Methodist Hospital, Houston, Texas

^* Address correspondence to Kevin E. Varner, MD, 6560 Fannin, Suite 400, Houston, TX 77030 (e-mail: kvarner{at}bcm.tmc.edu).

Background: A chronic anterior midtibial stress fracture is a serious, difficult-to-treat injury that can adversely affect an athlete’s career.

Hypothesis: The use of a reamed intramedullary nail for a chronic anterior tibial stress fracture is a safe and effective treatment for an athlete.

Study Design: Case series; Level of evidence, 4.

Methods: Seven collegiate-level athletes with 11 chronic anterior midtibial stress fractures were treated with reamed intramedullary nailing between 1997 and 2000. These patients were followed for a mean duration of 17 months.

Results: The mean age of the patients at the time of stress fracture diagnosis was 17 years. Seven of the fractures occurred in male athletes, whereas 4 occurred in female athletes. All patients had failed nonoperative treatment, including rest, activity modification, use of an orthosis, and low-intensity ultrasound stimulation, for a minimum of 4 months. Patients had experienced symptoms for a mean duration of 12 months. Clinical and radiological union occurred at a mean of 2.7 and 3 months, respectively. The mean duration for return to sports after surgery was 4 months. At last follow-up, all patients had full range of motion at the knee and ankle joints and were satisfied with the results. One patient developed bursitis at the tibial nail insertion site that was resolved with a steroid injection. Another patient sustained a traumatic fracture of the distal tibia 1 year after intramedullary nailing of the tibial stress fracture. This fracture healed with nonoperative treatment. No other complications were observed.

Conclusion: Intramedullary nailing of the tibia for chronic stress fracture has a high union rate, allows for a low complication rate, and allows for an early return to competitive sports. This procedure is an excellent alternative treatment for those fractures that have failed nonsurgical treatment.

Key Words: stress fracture • tibia • nailing

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