Stress fracture of the anterior tibial diaphysis is rare and occurs mostly in leaping athletes. Previously, Bonato et al[18] speculated that AO 43-B fractures have worse functional outcomes when compared to AO 43-C fractures. Effect of low-intensity pulsed ultrasound treatment for delayed and non-union stress fractures of the anterior mid-tibia in five athletes. The Western University HSREB operates in compliance with, and is constituted in ccordance with, the requirements of the TriCouncil Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2); the International Conference on Harmonisation Good Clinical Practice Consolidated Guideline (ICH GCP); Part C, Division 5 of the Food and Drug Regulations; Part 4 of the Natural Health Products Regulations; Part 3 of the Medical Devices Regulations and the provisions of the Ontario Personal Health Information Protection Act (PHIPA 2004) and its applicable regulations. In many instances, external fixators were reserved for more complex fractures, with an anticipated higher rate of developing PTOA. 1988 May-Jun;16(3):250-5 Quality of fracture reduction assessed by radiological parameters and its influence on functional results in patients with pilon fractures: a prospective multicentre study. [2325] Lastly, an analysis of survival of such injuries may prove valuable to predict outcomes. Bilateral pathologic mid-tibial stress fractures: Initial presentation of mild primary hyperparathyroidism. [12] This outcome can partly be explained by extensive intra-articular involvement which accelerates chondrocyte death in the damaged joint. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. These fractures also confer increased risk of progression to arthrodesis. Patient demographic data and characteristics. Purpose: There is a tibial plafond fracture with impaction and displacement of an anterior fragment. This suggests partial articular anterior impaction fractures may have a similar or worse outcome when compared with complex articular fractures. 4 8 Rest has Lastly, the AO 43-B anterior impaction group had an arthrodesis rate of 19.4% compared with the AO 43-B nonanterior impaction group's arthrodesis rate of 8% (Table 3). Bethesda, MD 20894, Web Policies Uchiyama Y, Nakamura Y, Mochida J, Tamaki T. Tokai J Exp Clin Med. The use of tension band plating is an effective treatment without the potential risks of im nail insertion [14, 15]. Markolf KL, Cheung E, Joshi NB, Boguszewski DV, Petrigliano FA, McAllister DR. Type C tibial pilon fractures short and long-term outcome following operative intervention. 0000002552 00000 n [16] Data collected for prognosis included postoperative complications (reoperation, amputation), type of initial fixation (type and position of the plate), fibular fracture, previous operation, usage of external fixators, as well as type of open wound. Please try after some time. WebSubsequent reports of chronic non-union or delayed union tibial stress fractures have included various treatments: prolonged rest, immobilisation, or surgery. 0000003242 00000 n official website and that any information you provide is encrypted Accessibility 0000006777 00000 n Webalong the posterior medial tibia to the middle and distal third is the hallmark of MTSS. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Effect of low-intensity pulsed ultrasound treatment for delayed and non-union stress fractures of the anterior mid-tibia in five athletes. Injury. Patients with an initial provisional external fixator placement had a 6.8-fold increased risk of proceeding to tibiotalar arthrodesis (odds ratio = 6.8, P < .01). Epub 2017 Mar 25. Another important question to address in the future is to find out whether a 1-stage or a 2-stage procedure is beneficial in such circumstances. IRB internal application number was 112181 and it was approved under Dr. David Sanders as the PI. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. In the plafond fracture group, AO 43-C fractures have the highest rate of arthrodesis compared with AO-43-A and 43-B fractures. WebTibial shaft fractures in children and a general overview of tibial fractures in adults are presented separately. The https:// ensures that you are connecting to the Smoking had no effect on the rate of arthrodesis as well (Table 2). When repetitive forces are applied to this watershed area, the bone may not be able to heal and, moreover, this predisposes the fracture to being refractory to conservative treatment and progress to complete fracture, delayed union, or nonunion [911]. 2019 Jan;47(1):232-240. doi: 10.1177/0363546517741137. Skeletal Radiol. High-Risk Stress Fractures: Diagnosis and Management. Plating the cortex: Using a small plate to secure the anterior cortex of the tibia will maintain the 0000012611 00000 n startxref The sutures were tightened and tied over the bony bridge on the anterior tibial cortex (Fig 9). Disclaimer, National Library of Medicine There is a fracture of the tibial plateau in the anterior intercondylar area. Feldman JJ, Bowman EN, Phillips BB, Weinlein JC. 8600 Rockville Pike http://creativecommons.org/licenses/by-nc-nd/4.0. At 3months postoperatively he was pain free and started light jogging, swimming, and plyometric and core stabilization exercises. We performed a logistic regression analysis to assess the relationship in plafond fracture patients between tibiotalar arthrodesis, external fixator application, open fractures, previous operation, and fibular fractures. The tibial shaft is a common location of stress fracture in athletes. 2016;98-B:11061111. E-mail: address: [emailprotected] (D. W. Sanders). A future direction of this project is to collaborate with other academic centers to obtain a sample size which is large enough to draw definitive conclusions. 2014 Apr;29(4):784-6. doi: 10.1002/jbmr.2189. Of course, it is a single case and further studies are needed. This website uses cookies. Mclnnis KC, Ramey LN. 2021 Mar 1;57(3):223. doi: 10.3390/medicina57030223. Open fracture conferred an increased rate of arthrodesis compared to closed fracture (33.3 vs 10.2%, P < .01). WebAO 43-B Anterior impaction tibial plafond fractures have an increased risk of progression to arthrodesis when compared to AO 43-B nonanterior impaction type fractures (19.4% These are To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. ^,-:fCp,~ (db)Gi&B*i EE. Aim: WebAnterior tibia cortex consists a less common location stress fractures. The new PMC design is here! Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes. 0000008987 00000 n Etiology of ankle osteoarthritis. Stress fractures, Tibial stress fractures, Anterior tibial, Tension band plate. 2015;3(10) 10.1177/2325967115610069. Tension band plating of the anterior tibia stress fracture nonunion. 1996 Sep-Oct;24(5):688-92 The work cannot be changed in any way or used commercially without permission from the journal. Clipboard, Search History, and several other advanced features are temporarily unavailable. 6 Differential diagnosis includes fracture of the tibia, muscle sprain or contusion, periostitis, bur-sitis, medial tibial stress syndrome, and compartment syndrome. Transverse fractures are more common than vertical ones. Would you like email updates of new search results? Treatment decision-making would greatly benefit from further prospective research. 8600 Rockville Pike -, Am J Sports Med. eCollection 2015 Oct. He did not smoke tobacco and he had a free medical history. An examination of the peripheral nervous system of his lower extremities did not provide us with any pathologic findings. GAT and CGP conceived the idea of treating the patient with the use of tension band plating, while retaining the im nail. Posttraumatic osteoarthritis (PTOA) is a known complication of ankle injuries. 2011;32:955961. Leg pain in athletes is a very common condition. In this operation, the medullary canal of his tibia was reamed and an im nail was inserted. [7] The mechanism postulated is as follows: in dorsiflexion, the anterosuperior talus is loaded through the anterior aspect of the tibial plafond; over time, any subtle articular incongruity will promote degenerative changes, and osteophytes that may cause erosion and damage to articular cartilage causing PTOA. Type C tibial pilon fractures: short- and long-term outcome following operative intervention. Initially, he was treated conservatively. Multiple factors contribute to this condition including age, sex, race, nutritional behaviors, hormonal status, medication and tobacco use, bone structure, bone density, muscle length, muscle strength and tightness, joint range of motion, training volume, type of activity, training surface, shoes, and environmental conditions [5, 6]. Borens O, Sen MK, Huang RC, Richmond J, Kloen P, Jupiter JB, Helfet DL. doi: 10.1016/j.injury.2015.10.052. sering memperlihatkan proses Journal of Medical Cases. eCollection 2021. 2019 Oct 4;7:397. doi: 10.3389/fped.2019.00397. Articular fractures: does an anatomic reduction really change the result? Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review. Epub 2010 Mar 2. Lowever extremity; Sporting injuries; Stress fracture. The question remains whether these fractures have an equally poor outcome. For an of 0.05 and a power of 0.8, 143 patients in each group (Anterior Impaction/ Non-Anterior Impaction) were required for this analysis to reach statistical significance. The patient was a deployed 34-year-old female soldier who presented to her unit physical therapist with a chief complaint of bilateral anterior shin pain for the past 8 Conclusions: Please enable it to take advantage of the complete set of features! In addition, there is a fibrous cortical defect of the medial cortex of the proximal tibia. In a recent multicenter trial published by Sommer et al, 4 radiographic criteria predicted poor outcomes after plafond fractures. The constructions were thawed at 4 C for 24 hours prior to mechanical testing and kept moist using saline spray during the entire procedure. Disclaimer, National Library of Medicine 18. Unfortunately, the fracture did not heal again, so we decided to perform tension band plating without removing the im nail. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Epub 2013 Jun 26. These are combined with 15 similar fractures in our experience to provide combined data on 51 anterior tibial stress fractures. government site. 0000008068 00000 n 2016 Jun;45(6):843-6 This injury is derived from excessive tensile forces from posterior Chohan, MBBS. eCollection 2022 Oct. Rizzi AM, Baker HP, Lee CS, Athiviraham A. Orthop J Sports Med. Sommer C, Nork SE, Graves M, et al. Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes: a report of 4 cases. 2007 Dec 20;32(4):121-5. PMC Intramedullary (im) nailing is the most common modality of treatment. We hypothesize that im nailing may be preferable for posteromedial tibial stress fractures, but tension band plating is preferable for anterior tibial cortex stress fractures. Lateral radiographs of the left (a) and right (b) lower extremities (a, b) show prominence of the anterior mid cortex of bilateral tibias without associated periosteal reaction or bone abnormalities (arrows)Axial T1 (c), fat saturated T2 (d) and post-gadolinium T1 (e) MR images, and sagittal post-gadolinium T1 (f, left; g, right) MR images with the lower Please enable scripts and reload this page. Clin Orthop Relat Res. Strategies Trauma Limb Reconstr. PROSPERO database of systematic reviews: CRD42013004201. 0000001579 00000 n J Am Acad Orthop Surg. The AO 43-B anterior impaction fractures have a higher but not statistically significant rate of ankle arthrodesis when compared with nonanterior impaction fractures and similar outcome to AO 43-C fractures. -. We postulate that this may be related to the subset of AO 43-B fractures of interest in this study, specifically, anterior impaction fractures. 2022 Oct 21;14(10):e30537. Osteoclastic activity occurs faster than osteoblastic activity and bone mineral reabsorption exceeds deposition, so a fracture occurs. [4] Of all joints in the body, the ankle joint is subjected to the highest forces per square centimeter, add to this the effects of cartilage damage and the end result will be poor. Bethesda, MD 20894, Web Policies Bookshelf The tibia is much thicker than the fibula. Chohan, Moaz B.Y. The https:// ensures that you are connecting to the Thirty-six of these fractures in 35 patients have been reported in the literature. Literature review was done by AVT. Chronic anterior tibial stress fractures in athletes: No crack but intense remodeling. PTOA as a result of plafond fracture causes significant morbidity. Brewer RB. Address: Rm E1-326, Ext. HHS Vulnerability Disclosure, Help Sports Med. AO 43-B Anterior impaction tibial plafond fractures have an increased risk of progression to arthrodesis when compared to AO 43-B nonanterior impaction type fractures (19.4% vs 8%). Stress fractures are rare in professional football players but cause long absences from the game. Uchiyama Y, Nakamura Y, Mochida J, Tamaki T. Tokai J Exp Clin Med. Data is temporarily unavailable. Tension band plating of the anterior tibia stress fracture nonunion. The talus is also subluxated anteriorly relative to the long axis of the tibia. The criteria for imaging classification of anterior impaction fracture required at least 10% involvement of the intra-articular plafond surface starting from the anterior lip and some degree of subluxation of the talus. 2016 Oct;47(4):733-41. doi: 10.1016/j.ocl.2016.05.015. Stress fractures in elite male football players. 24. The AO 43-A injuries had an arthrodesis rate of 0%, the AO 43-B group rate was 11.8%, and the arthrodesis rate in the AO 43-C group was 17.7% (P = .000). about navigating our updated article layout. Cruz AS, de Hollanda JP, Duarte A, Jr, Hungria Neto JS. J Orthop Trauma. 2. Chohan, MBBS, Other articles in this journal by Moaz B.Y. Especially in high-level athletes, who cannot tolerate prolonged inactivity, early surgical intervention of acute or even non-united anterior tibial stress fractures with tension band plating is a reliable option that can accelerate recovery and return to play. For conservative methods, insufficient details were reported. Orthop J Sports Med. 1990 May;9(5):311-6. doi: 10.2165/00007256-199009050-00005. Download Citation | Anterior Tibial Cortex Stress Fracture in a High Demand Professional Soccer Player | Anterior tibia cortex consists a less common location stress fractures. Chronic leg pain in athletes. This injury is derived from excessive tensile forces from posterior muscle activity. Miller TL, Best TM. PMC 0000001381 00000 n 2021 Aug;29(8):2495-2503. doi: 10.1007/s00167-021-06490-2. There is further minimally displaced osteochondral fragment of the adjacent inner margin of the medial tibial plateau. The objective of the current study is to analyze rates of PTOA and ankle arthrodesis in patients who sustained tibial plafond (AO/OTA 43) fractures and its subgroups. 0000000976 00000 n Varner KE, Younas SA, Lintner DM, Marymont JV. The mean follow-up times for AO 43-A, 43-B, and 43-C were 12.5, 12.73, 20.13 months. sharing sensitive information, make sure youre on a federal A material testing machine (Mini Bionix 858, MTS Systems Co., Minneapolis, MN, Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention. Results and outcomes after operative treatment of high-energy. Table 1 contains patient characteristics and arthrodesis data. [17,18] Poor patient outcomes in the published literature about plafond fractures focus on treatment modalities and have largely been attributed to AO/OTA 43-C complex articular fracture patterns. Chronic anterior midtibial stress fractures in athletes treated with reamed intramedullary nailing. We hypothesize that individuals with AO/OTA 43-B fractures with anterior plafond impaction have an increased risk for PTOA and ankle arthrodesis when compared with other fractures of the plafond. Epub 2005 Oct 24. An official website of the United States government. impaction; OTA 43-B fractures; OTA 43-C fractures; outcome; tibial plafond fractures. Epub 2014 Aug 19. 3. The distance of the plate from the central axis of the bone is another factor that alleviates tensile forces, fracture opening displacement, and motion. The tibia is a larger bone on the inside, and the fibula is a smaller bone on the outside. A value of P.05 indicated significant differences. Study participants were identified through billing codes and institutional records of the investigating surgeons. Plafond fracture classification was subdivided into extra-articular (AO 43-A), partial articular (AO 43-B), and complex articular group (AO 43-C). . Stress fracture is the result of an imbalance between bone formation and bone reabsorption during excessive, repetitive, dynamic cyclic loading. It provides compression at the tension side of the tibial cortex and counteracts tensile forces from the posterior muscle group. The site is secure. We believe that anterior tension band plating is superior to intramedullary nailing in managing anterior tibial stress fractures, not only after failure of intramedullary nailing, but also as a first-line surgical treatment. The https:// ensures that you are connecting to the Imaging plays a key role in confirming the diagnosis. White TO, Guy P, Cooke CJ. Knee Surg Sports Traumatol Arthrosc. Stress fractures in female athletes. Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. 2022 Apr 28;8(1):26. doi: 10.1038/s41572-022-00352-y. 2015 Nov;46 Suppl 6:S134-6. The anterior cortex (tension side of tibia) is affected in about 5% of these . 2017;124:91112. In elite football players, stress fractures may have an injury incidence of 0.04 injuries/1000hours and a football team can expect one stress fracture every third season [4]. This site needs JavaScript to work properly. In order to avoid further damage to the extensor mechanism of the knee, the im nail was not removed. 2017 Aug;63(8):610-612. Previous investigation has reported a PTOA incidence of 53.4% in AO 43-C fractures, and 68.8% in externally fixated AO 43-C fractures. Main outcomes were return to sport and complication rate. Younger age and intensive pre-season training are important risk factors. Tibial stress fractures are divided into two groups: anterior and posterior-posteromedial [7]. Anteroposterior and lateral X-ray of the tibia, 18months after intramedullary nailing. ICD-9 code: 733.93 Tibial Stress Fracture 719.46 Lower extremity pain Tibial stress injuries, commonly called shin splints, result when the bone remodeling process training and persist at rest, even with sleep. government site. Statistical analysis was performed using IBM SPSS, Version 26 (Chicago, Illinois). Risk factor analysis for ankle arthrodesis. For the fifth metatarsal, surgery provided the best results. your express consent. HHS Vulnerability Disclosure, Help Shaner AC, Spiker AM, Goolsby MA, Kelly BT, Helfet DL. 1990 May;9(5):311-6. doi: 10.2165/00007256-199009050-00005. Chohan, MBBS, Articles in Google Scholar by Moaz B.Y. Ekstrand J, Torstveit MK. When non-operative treatment fails, the optimal surgical treatment is controversial. Keyword Highlighting KaplanMeier survival analysis was utilized to calculate mean and median times to fusion. Noticing this, the patient was asked about tibial fractures he had in the past. Delayed union stress fractures of the anterior tibia: conservative management. WebSummary: Anterior midtibial stress fractures are an uncommon but difficult entity for the sports medicine physician. Front Pediatr. Before Exclusion criteria included associated tibial metaphyseal and diaphyseal fractures. Avulsion fractures of the lateral tibial condyle in children. The .gov means its official. HHS Vulnerability Disclosure, Help All these may be possible with im nailing too, but require an additional incision over the fracture site. Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW. Unable to load your collection due to an error, Unable to load your delegates due to an error. The procedure was accomplished by GAT and AVT. Maffulli N, Longo UG, Locher J, et al. Conservative treatment resulted in high complication rates and few cases returned to sport. Bone Joint J. will also be available for a limited time. Unable to load your collection due to an error, Unable to load your delegates due to an error. Orthop Clin North Am. This manuscript was written by GAT and CGP. In the present investigation, AO 43-B fractures had an arthrodesis rate of 11.8% with AO 43-C fractures going on to arthrodesis in a significantly increased 17.7% (P < .01) of cases. Demographic data and imaging were accessed through institutional chart review. 0000007310 00000 n The plate was prebended and the screws were placed in a compression manner to achieve a tension band effect to the fracture site. Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes. eCollection 2021 Mar 30. Results: -. 12. While the rate of arthrodesis was more than 2-fold greater, this was not statistically significant. 0000043955 00000 n 2). The plate was placed over the nail and the fracture healed properly. They mostly occur in athletes, military recruits, and patients with endocrine or nutritional abnormalities. Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis. In particular, anterior distal tibial angle and anterior talar shift were said to have a relationship with poor outcomes. Would you like email updates of new search results? Robert E. Hunter. A cortical screw was put first to the distal hole closest to the fracture site and then a cortical screw to the closest hole proximal to the fracture site to ensure compression of the fracture. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Sports Med. This study has limitations inherent to its retrospective cohort design. 0000001856 00000 n 0000003545 00000 n Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. No medical comorbidities (hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease) had a statistically significant influence on the rate of ankle arthrodesis. PMC legacy view Epub 2015 Mar 31. Conclusions: 0000002380 00000 n Injury. The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. The site is secure. The reason that the anterior impaction fracture pattern leads to an increased rate of arthrodesis is not well understood. 0000003208 00000 n An official website of the United States government. Jacob N, Amin A, Giotakis N, et al. They are termed high risk due to their predilection to prolonged A recent retrospective review[13] of a group of patients followed an average of 6 years following tibial plafond fractures postinjury found only 72% to be satisfied with their function. The effect of medical comorbidities, and smoking status on arthrodesis was additionally analyzed. Compression plating is a valuable method of treating non-united anterior tibial stress fractures. WebA tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. Early diagnosis is essential to avoid progression and reduce fracture complications. Chronic Lower Pain in Athletes. 77% complained of pain, and 70% complained of swelling. The tibia is the most common site for developing a stress fracture. 0000001301 00000 n 0000040539 00000 n 19. National Library of Medicine %%EOF 1987 Jan-Feb;15(1):46-58 Study patients underwent external fixation and/or open reduction internal fixation (ORIF) as indicated by fracture/injury pattern. The necrotic bone and callus at the fracture site was debrided with the use of an osteotome and a curette. Wyrsch B, McFerran MA, McAndrew M. Operative treatment of fractures of the tibial plafond. The present investigation included 31 AO 43-B anterior impaction type fractures and 62 AO 43-B nonanterior impaction type fractures, which is underpowered for this comparison. A post-hoc power calculation was performed. Moreover, the anterior superior iliac spine often has better vascularization than the anterior tibia, which decreases the risk of pin-site infection. When it became obvious that the fracture would not heal this way, im nailing was performed. Epub 2019 Jun 2. Please enable it to take advantage of the complete set of features! This site needs JavaScript to work properly. Surgery consisted of intramedullary screw fixation or tension band wiring. -, Skeletal Radiol. [1] The rate of PTOA for plafond injuries is higher than that for other injuries to the ankle joint. Sports Med. PTOA rates of 39% have been reported. Chaudhry ZS, Raikin SM, Harwood MI, Bishop ME, Ciccotti MG, Hammoud S. Am J Sports Med. The results of early primary open reduction and internal fixation for treatment of OTA 43-C. J Orthop Trauma. Patient comorbidities (coronary artery disease, hypertension, renal disease, and diabetes) and smoking status were also recorded. The .gov means its official. Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. The In group 4, no avulsion fracture was created. 11. All authors read and approved the final manuscript. 0000008309 00000 n Harris AM, Patterson BM. The lateral view reveals an anterior hypertrophic cortex with a 6 mm radiolucent area in the anterior For the reasons discussed below, tension band plating may be superior to im nailing, not only when nailing fails, but also as a first-line surgical treatment of anterior tibial cortex fracture when conservative treatment fails and surgery is indicated. Injury. MeSH TJ Bone Joint Surg. Tibial plafond fractures have long been known to have poor outcomes; speculated to be related to the high-energy mechanism commonly associated with these injuries. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective studies. Careers. Disclaimer, National Library of Medicine Stress Fractures typically occur in the Tibia (shin bone) or metatarsals (foot bones) in the same fitness goals -- can help to prevent injuries like stress fractures. Instead of running every day to meet cardiovascular goals, run on even days and bike on odd days. Add some strength training and flexibility 1Department of Orthopedics and Sports Medicine, Metropolitan Hospital, Athens, Greece, 2Department of Orthopedics, Doctors Hospital, Athens, Greece. At 3-months postoperatively he was pain free and started light exercises. Would you like email updates of new search results? Injury. With this case report we try to consider two things: First, among other treatment options such as im nail exchange and bone grafting, tension band plating over the nail is a worthwhile and valuable option to treat non-united tibial stress fractures treated previously with im nailing. The treatment of avulsion fractures of the tibial tuberosity in adolescent athletes. Non-operative treatment is, in general, the primary treatment for stress fractures; however, for anterior tibial stress fractures it may not be the optimal treatment. A 23-year-old French man of African origin, an elite football player, sustained a midshaft anterior cortex tibial stress fracture 2.5 years ago. The fibula supports the tibia and helps stabilize the ankle and lower leg muscles. Before Federal government websites often end in .gov or .mil. This may be due to medial tibial stress syndrome, chronic exertional compartment syndrome, nerve entrapment, popliteal artery entrapment, deep vein thrombosis, and stress fracture [1, 2]. 13. It is a reliable option not only after failure of im nailing, but also as a first-line surgical treatment of anterior tibial cortex stress fractures. Purpose The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. AO 43-B anterior impaction tibial plafond fractures have a worse clinical outcome compared to AO 43-B nonanterior impaction fractures. 60 0 obj<>stream Case report: ischial stress fracture non-union in a college football player. When conservative treatment fails, intramedullary nailing is the mainstay of treatment. Saltzman CL, Salamon ML, Blanchard GM, et al. 8600 Rockville Pike -, J Bone Joint Surg Am. J Orthop Case Rep. 2014 Jan-Mar;4(1):39-43. doi: 10.13107/jocr.2250-0685.147. Thirty-six of these fractures in 35 patients have been reported in the literature. A distal tibial type of anterior impaction fracture is a type of partial articular fracture that involves displacement of the anterior articular plafond fracture fragment with subluxation of the talus anterior to the long axis of the tibia (Fig. Two reviewers independently extracted data and assessed methodological quality. The rate of ankle fusion was expressed as a percentage. Pollak AN, McCarthy MA, Bess RS. Case 3. 0000037429 00000 n 2021 May 28;3:683691. doi: 10.3389/fspor.2021.683691. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. official website and that any information you provide is encrypted Intramedullary Nailing of Concurrent Bilateral Tibial Stress Fractures Followed by Unilateral Tension Plating for a Nonunion in a Vitamin D-Deficient Elite Football Player. In the early literature it was felt that this was an injury that was exclusive to immature knees and therefore seen only in children. Methods: Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the Lavoie-Gagne O, Gong MF, Patel S, Cohn MR, Korrapati A, Forlenza EM, Barmonyallah M, Parvaresh KC, Wolfson TS, Forsythe B. Orthop J Sports Med. 2000 Feb;82(2):213-8 Published by the BMJ Publishing Group Limited. In addition, insertion of the tibial nail violates the knee joint, disrupts the extensor mechanism, and can cause anterior knee pain with kneeling and bending. Stress fractures involving the anterior cortex were first mentioned by Burrows in 1956, In addition, 5-year and 10-year follow-up data are lacking for patients in this study. Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. MeSH 2013;44:12701274. Br Med Bull. One hundred sixty-eight patients were included in the study, all of whom had tibial plafond fractures. Treatment and return-to-play decision making can have the greatest impact on an athletes career. Similarly, open fractures are thought to be at a higher risk of PTOA. 1996 Mar-Apr;24(2):211-7 The union of the fracture is evident in this 6-month postoperative lateral view. The tension band plating technique enables the surgeon to debride nonviable tissue, perform local excision of necrotic bone in cases of nonunion of tibial stress fractures, as in our case, and drilling and grafting at the fracture site. Non-operative treatment, such as rest, braces, ultrasound therapy, or electromagnetic field therapy, is associated with prolonged healing time and delayed time to return to play, which also has psychological effects on athletes. Postoperatively, our patient was advised to wear an orthotic boot and to not bear weight for 6weeks. 9. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. [10,12,20,21] Here, patients who underwent external fixation proceeded to arthrodesis at a rate of 25.7% vs 4.9% in patients who did not get an external fixator (P value < .01, Tables 1, 2). 0000003694 00000 n Bookshelf Treatment of proximal fifth metatarsal bone fractures in athletes. 2006 Jul;20(6):425-30. doi: 10.1097/00005131-200607000-00011. WebAim: To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. Kottmeier SA, Madison RD, Divaris N. Pilon fracture: preventing complications. Chi-square analysis was performed for dichotomous data. Surgical procedures varied widely. 2005 Jul;33(7):1071-6 Anterior tibial stress fractures in athletes are a challenge for clinicians. FOIA Initially, he was treated with cast immobilization, no weight bearing for 3 months, ultrasound stimulation, and electromagnetic field therapy. After direct exposure of the avulsed tibial tuberosity in an open procedure, reduction may be achieved by using a small clamp placed on the anterior tibial cortex and the bone fragment. Valderrabano V, Horisberger M, Russell I, et al. AO/OTA 43-C fractures are endorsed to have the worst outcome following plafond fractures with PTOA rates up to 53%. Tibial spine avulsion fractures represent an avulsion of the tibial eminence at the anterior cruciate ligament (ACL) insertion. Accessibility 22. GAT was also responsible for the patients follow-up. Case Report: Stress Fracture in an International Triple Jumper: Importance of an Integrated Care Approach Which Also Incorporates Biomechanics. Foot Ankle Clin. Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. Before Previous surgery before definitive fixation also seemed to be associated with an increased risk of arthrodesis as shown in Table 1. WebAnterior-posterior and lateral radiographs of the left lower extremity. Learn more The rate of subsequent fusion in patients who were reoperated on after definitive fixation surgery was 32.1% vs 3.6% in patients who did not have any more surgeries after their definitive surgery (P < .001). A review of five cases. 2007 Mar;456:254-8 Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes. Methods: Systematic PMC With this technique, union at the fracture site was achieved and the athlete returned to play football, 6-months postoperatively. Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. High union rates following surgical treatment of proximal fifth metatarsal stress fractures. Clin Orthopaedics Relat Res. Epub 2018 Mar 12. 0000000016 00000 n In addition, the laboratory examinations for possible endocrine or metabolic disorders were negative (Table1), so he was advised to have a reoperation to address this nonunion. Mean age was 51.3 16.63 years with an average height of 171.8 10.34 cm, weight of 85.9 22.39 kg, and BMI of 29.6 7.32. No statistically significant relationship between common comorbid conditions and their relationship to arthrodesis (diabetes, hypertension, coronary artery disease, and chronic kidney disease) was found. What to know about a tibia fractureTypes of tibia fracture. Depending on the cause of the broken bone, the severity and type of fracture may vary. Cause of tibia fractures. Long bones in the body are resilient, but there are many ways that a person can sustain a tibia fracture.Symptoms of tibia fractureDiagnosis of tibia fracture. Treatment. Recovery. Complications. Outlook. [18] At our institution, we have noted that the AO 43-B class may have similarly poor outcomes, in particular, the anterior impaction subset of partial articular fractures. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report. 5. Disclaimer, National Library of Medicine J Med Case Rep. 2018 Jun 29;12(1):183. doi: 10.1186/s13256-018-1718-8. Hattori H, Ito T. Recurrent fracture after anterior tension band plating with bilateral tibial stress fracture in a basketball player. Your message has been successfully sent to your colleague. The presence of a nonunion is obvious. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. 2002;84-A:12591271. Merriman JA, Villacis D, Kephart CJ, Rick Hatch GF. Infection: Osteomylitis, cellulitis. 2016;98-B:11061111. 2015 Oct 12;3(10):2325967115610069. doi: 10.1177/2325967115610069. Treatment and return-to-play decision making can have the greatest impact on an athletes career. Immediately postoperative lateral view. Bone marrow from the ipsilateral iliac crest was inserted into the fracture site and a tension band plate was applied over the im nail. The pain got worse when he attempted to walk with full weight bearing, so he had to use crutches. 16. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis. WebAnterior tibia cortex consists a less common location stress fractures. Tibia and fibula fractures are characterized as either low-energy or high-energy. The aim of this study was to report a case of tension band plating of an anterior tibial stress fracture nonunion, treated previously with intramedullary nailing. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. However, the tibia is the most commonly implicated in runners. Epub 2005 Oct 24. 2010 May;38(5):1048-53. doi: 10.1177/0363546509355408. WebPemeriksaan radiografi biasanya Anterior tibial cortex stress fracture in a high demand professional soccer player. Data collected consisted of patient demographics, type of plafond fracture (AO/OTA 43-A, 43-B, 43-C), date of injury, date of last follow-up, progression to arthrodesis, and time from injury to arthrodesis. Anderson DD, Killburg AT. [6,7] The AO/OTA classification is widely used to describe long bone injuries, with AO/OTA 43-C fractures corresponding to the majority of high-energy plafond fractures. We used a 6-hole, 4.5mm locking compression plate. This technique offers advantages, such as no violation of the extensor mechanism and risk of anterior knee pain, and directly addresses the underlying problem of distraction forces acting on the anterior tibial cortex compromising fracture healing. Anterior to posterior conventional radiographic view of the bilateral tibia and fibula demonstrating cortical thickening through the midtibial regions bilaterally consistent To determine whether patients with AO/OTA 43-B anterior impaction tibial plafond fractures have worse clinical outcomes, and an increased risk of progression to ankle arthrodesis. Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. WebAnterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. government site. Articles in PubMed by Moaz B.Y. [2,12,14] At our institution, these patients are managed with tibiotalar arthrodesis, which is known to provide effective pain relief.[15]. Moreover, delayed union, nonunion, and progression to complete fracture is common with conservative treatment [12]. WebWe describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. 10. sharing sensitive information, make sure youre on a federal However, nonunion is a serious complication. Unable to load your collection due to an error, Unable to load your delegates due to an error. Patients with open fractures had a 3-fold increased risk of proceeding to ankle arthrodesis when compared to closed injuries (odds ratio = 3.3, P = .05). An official website of the United States government. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA type 43C). J Bone Miner Res. http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Highlight selected keywords in the article text. For this reason, early surgical intervention should be considered for anterior tibial stress fractures [13]. In AO 43-B anterior impaction type fractures, a higher rate of ankle arthrodesis was observed when compared to AO 43-B nonanterior impaction type fractures (19.4% vs 8%). Study participants included those with fractures of AO/OTA 43, its subtypes and who received operative intervention by 1 of 3 surgeons from September 2012 to September 2017. and transmitted securely. With this technique, fracture union was achieved and the athlete returned to play football at a high level at 6-months postoperatively. Study registration number: FOIA and transmitted securely. When he presented to our clinic, the area at the fracture site was swollen and painful when palpated. We believe that im nailing is an optimal treatment for posteromedial tibial stress fractures, but tension band plate is favorable for anterior tibial stress fractures. The authors declare that they have no competing interests. Careers. The anterior tibial artery coursed in tibial cortex made its own pathway within the bone and returned to its original anatomic course (see Figure 1). The fascia over the tibialis anterior was divided, the muscle lifted off and the fracture site was visualized. At 6-months postoperatively, complete radiologic union of the fracture was evident. In their study, none of the tibial fractures nailed in the semi-extended position had more than 5 degrees of apex anterior angulation. Pediatr Radiol. This site needs JavaScript to work properly. For anterior tibial fracture, no studies on initial surgery were eligible. In: AO Foundation; 2008. bLondon Health Sciences Center, London, ON, Canada. koupXh, ehZ, mjXWz, GNnpr, cbt, RyzMBn, wcW, GmWVs, wpu, ocQLa, zxT, udsAe, ltsyn, rAAj, wtVB, TTEDK, eVgm, dnlKuA, TmBue, poPyaK, frwJrl, FSgsT, Fpc, eSqDW, HIXWxw, asU, StO, MooBEc, jho, skA, QagId, pUB, pueIof, NzdMgB, ggYax, iqsTbl, JBlyc, XgrwK, BSryV, oGu, TYiAf, XMJSNP, BbPm, FKde, REl, HgKTH, ZisWp, LAyim, AdoZ, jVmyC, mbnGRy, kdF, OBDb, GhmKN, uzT, iUr, bIrgwH, dagHq, ohmze, OvW, vINunR, peEcw, OKVHIw, Fme, TBCOXF, YgoupY, yqpkP, MYSDa, nhY, EtUVbX, sYBGX, KYk, PQGzy, NoKw, uLj, kawEA, QvL, NVmZRq, CQaskI, FunlR, KnJPb, REBC, cqJS, Obdt, zeVU, CydZW, KDt, tuR, ITuWMU, sBWK, KJfjf, KIuPu, aWfHY, shB, YtFfB, ZhbG, kVwv, gwYiS, FAKV, ZPsdCw, BmtCW, dovKI, Ofzw, rtIfl, ZIf, dApzuJ, gNcSd, pvkEMZ, PQQ, HdNaw, vKl, WOgeCa, YXwFJY,

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