Davidovitch RI, Elkhechen RJ, Romo S, et al. 2021 Mar 31;13(1):9108. doi: 10.4081/or.2021.9108. 2017 Sep;46(9):1165-1186. doi: 10.1007/s00256-017-2632-7. Second, we considered what the optimal surgical treatment for the special category of anterior tibial cortex stress fractures would be. 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. While standing in the arthroscopic treatments of avulsion fractures from the street, he was hit by a car on the lateral aspect of his tibial insertion of the PCL have been reported.8-12 left knee. 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%). 0000008615 00000 n the strand were fixed on the anterior tibial cortex. 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. Iowa Orthop J. The site is secure. 2006 Jul;20(6):425-30. doi: 10.1097/00005131-200607000-00011. Bonato LJ, Edwards ER, Gosling CM, et al. 0000022018 00000 n Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. [2,12,14] At our institution, these patients are managed with tibiotalar arthrodesis, which is known to provide effective pain relief.[15]. Chohan, MBBS, Other articles in this journal by Moaz B.Y. 2009;467:18001806. 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% Knee Surg Sports Traumatol Arthrosc. HHS Vulnerability Disclosure, Help Anterior to posterior conventional radiographic view of the bilateral tibia and fibula demonstrating cortical thickening through the midtibial regions bilaterally consistent Avulsion fractures of the lateral tibial condyle in children. 0000003208 00000 n Similarly, open fractures are thought to be at a higher risk of PTOA. Please enable it to take advantage of the complete set of features! Please enable it to take advantage of the complete set of features! 2021 Aug;29(8):2495-2503. doi: 10.1007/s00167-021-06490-2. Injury. 2009;23:6067. Early diagnosis is essential to avoid progression and reduce fracture complications. At 6-months postoperatively, complete radiologic union of the fracture was evident. 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. 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. A review of five cases. Chohan, MBBS, Articles in Google Scholar by Moaz B.Y. Borens O, Sen MK, Huang RC, et al. This suggests partial articular anterior impaction fractures may have a similar or worse outcome when compared with complex articular fractures. It is known that up to 70% of end-stage ankle arthrosis is posttraumatic in nature. Conclusions: Infection: Osteomylitis, cellulitis. 6. The treatment options for such cases include nail exchange, drilling of the fracture site, bone grafting, or removal of the nail and internal fixation with a plate. Strategies Trauma Limb Reconstr. The role of initial surgery is unknown. The union of the fracture is evident in this 6-month postoperative lateral view. Case Report: Stress Fracture in an International Triple Jumper: Importance of an Integrated Care Approach Which Also Incorporates Biomechanics. 0000001381 00000 n 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 and compromising fracture healing. 25-OH vitamin D calcifediol, ALP alkaline phosphatase, ALT alanine aminotransferase, AST aspartate aminotransferase, ESR erythrocyte sedimentation rate, Hct hematocrit, Hgb hemoglobin, iPTH intact parathyroid hormone, RBC red blood cells, SGOT serum glutamic oxaloacetic transaminase, SGPT serum glutamic pyruvic transaminase, TSH thyroid-stimulating hormone, WBC white blood cells. An official website of the United States government. George A. Tsakotos, Email: moc.liamg@sotokastg. Management of tarsal navicular stress fractures: conservative versus surgical treatment: a meta-analysis. Highlight selected keywords in the article text. No statistically significant relationship between common comorbid conditions and their relationship to arthrodesis (diabetes, hypertension, coronary artery disease, and chronic kidney disease) was found. IRB internal application number was 112181 and it was approved under Dr. David Sanders as the PI. The tibial shaft is a common location of stress fracture in athletes. 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. . Robert E. Hunter. X-rays and computed tomography (CT) scans were utilized for differentiation between tibial plafond, bi-malleolar, and tri-malleolar fractures. Plating the cortex: Using a small plate to secure the anterior cortex of the tibia will maintain the Methods: HHS Vulnerability Disclosure, Help 1997 Dec;24(6):419-29. doi: 10.2165/00007256-199724060-00006. 2000 Feb;82(2):213-8 Careers. In the early literature it was felt that this was an injury that was exclusive to immature knees and therefore seen only in children. Lowever extremity; Sporting injuries; Stress fracture. At 3months postoperatively he was pain free and started light jogging, swimming, and plyometric and core stabilization exercises. 2015 Nov;46 Suppl 6:S134-6. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Am J Sports Med. 1996;78:16461657. To date, this is the only study to compare ankle arthrodesis rates in patients having sustained tibial plafond anterior impaction fractures. 20. 25. Intramedullary nailing for chronic tibial stress fractures. PTOA rates of 39% have been reported. Recurrent Fracture After Anterior Tension Band Plating With Bilateral Tibial Stress Fracture in a Basketball Player: A Case Report. All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. The anterior cortex (tension side of tibia) is affected in about 5% of these . The .gov means its official. Surgery consisted of intramedullary screw fixation or tension band wiring. Posterior-posteromedial cortex fractures are more frequent and respond well to conservative treatment. Hollander JJ, Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs GMMJ. Careers. and transmitted securely. Please try after some time. Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis. Epub 2019 Jun 2. 1) that a nonunion of the fracture had occurred. The authors declare that they have no competing interests. sharing sensitive information, make sure youre on a federal Stress fracture of the anterior tibial diaphysis is rare and occurs mostly in leaping athletes. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. These findings are not surprising; as patients with open fractures and temporizing external fixation often have sustained higher energy trauma. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. PTOA as a result of plafond fracture causes significant morbidity. The effect of medical comorbidities, and smoking status on arthrodesis was additionally analyzed. Careers. Am J Sports Med. An examination of the peripheral nervous system of his lower extremities did not provide us with any pathologic findings. 21. AO/OTA 43-C fractures are endorsed to have the worst outcome following plafond fractures with PTOA rates up to 53%. MBBSa; Del Balso, Christopher MBBS, MSc, FRCSCa; Ching, Michael MDa; Schemitsch, Emil MD, FRCSCb; Lawendy, Abdel Rahman MD, PhD, FRCSCb; Sanders, David W. MD, MSc, FRCSCb,. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bethesda, MD 20894, Web Policies Front Pediatr. Disclaimer, National Library of Medicine Reinking MF. Dailey SK, Archdeason Chronic bilateral tibial stress fractures with valgus treated with bilateral intramedullary nailing: a case report. Palpable callous, swelling or erythema in the area may indicate a stress bursa does not over lap with the region of tibial MTSS or fracture. 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). 0000003694 00000 n We believe that anterior tension band plating is superior to im nailing in managing anterior tibial stress fractures. Logistic regression was performed to control confounding. Six weeks of non-weightbearing cast was mostly used as conservative treatment. Bookshelf ACL avulsion injuries can be classified into four different types - this is a type 4 injury. The use of tension band plating is an effective treatment without the potential risks of im nail insertion [14, 15]. 2). Address: Rm E1-326, Ext. We presented a case of tension band plating of an anterior tibial stress fracture nonunion, treated previously with im nailing. Methods: Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Chronic leg pain in athletes. Main outcomes were return to sport and complication rate. J Hip Preserv Surg. Chung JS, Sabatino MJ, Fletcher AL, Ellis HB. We present a case where an anterior tibial stress fracture in an elite athlete did not heal after im nailing. 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). [10] If patients with PTOA of the ankle have refractory pain and are functionally limited, surgical intervention in the form of tibiotalar arthrodesis or total ankle arthroplasty (TAA) may be indicated. to maintaining your privacy and will not share your personal information without Effect of low-intensity pulsed ultrasound treatment for delayed and non-union stress fractures of the anterior mid-tibia in five athletes. Tensile forces created by the gastrocnemius and soleus musculature and relative hypovascularity lead to a high rate of nonunion, delayed union, and stress fracture at the anterior tibial cortex. 0000002380 00000 n The surgical procedure of triplanar osteotomy and transverse distraction. sharing sensitive information, make sure youre on a federal 1). Specific stress fractures are discussed eCollection 2021. [8] As such, AO/OTA 43-C fractures are expected to have the highest rates of PTOA and the worst functional outcomes. sharing sensitive information, make sure youre on a federal After that period, the fracture site still was not healed, so he underwent an operation performed by his team doctor. 6 Differential diagnosis includes fracture of the tibia, muscle sprain or contusion, periostitis, bur-sitis, medial tibial stress syndrome, and compartment syndrome. Horisberger M, Valderrabano V, Hintermann B. Posttraumatic ankle osteoarthritis after ankle-related fractures. 2019 Oct 4;7:397. doi: 10.3389/fped.2019.00397. [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. Foot Ankle Int. sharing sensitive information, make sure youre on a federal 2021 May 28;3:683691. doi: 10.3389/fspor.2021.683691. Blank S. Transverse tibial stress fractures. Injury. WebSummary: Anterior midtibial stress fractures are an uncommon but difficult entity for the sports medicine physician. Borens O, Sen MK, Huang RC, Richmond J, Kloen P, Jupiter JB, Helfet DL. Shaner AC, Spiker AM, Goolsby MA, Kelly BT, Helfet DL. WebA tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. The fracture did not heal; he had pain during gait, so he continued no weight bearing for 3 additional months. 0000003619 00000 n 0000002753 00000 n Ditmars FS, Ruess L, Young CM, Hu HH, MacDonald JP, Ravindran R, Thompson BP. 2001 Feb;35(1):74-7. doi: 10.1136/bjsm.35.1.74. Clin Orthopaedics Relat Res. This site needs JavaScript to work properly. FOIA 2021 Sep 8;9(9):23259671211024218. doi: 10.1177/23259671211024218. 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 https:// ensures that you are connecting to the There is a tibial plafond fracture with impaction and displacement of an anterior fragment. 3 and and4).4). Bone Joint J. eCollection 2021 Sep. Moore ML, Haglin JM, Hassebrock JD, Anastasi MB, Chhabra A. Orthop Rev (Pavia). The https:// ensures that you are connecting to the Orthop J Sports Med. However, nonunion is a serious complication. Posttraumatic osteoarthritis (PTOA) is a known complication of ankle injuries. limited bending motion in and around your knee. Simply so, what does a tibia stress fracture feel like? A stress fracture typically feels like an aching or burning localized pain somewhere along a bone. Sometimes, if the stress fracture is along a bone that has a lot of muscles around it, like the tibia or femur, these muscles will feel very tight. In this operation, the medullary canal of his tibia was reamed and an im nail was inserted. Stress fractures are rare in professional football players but cause long absences from the game. 2006 Jan;37(1):57-60. doi: 10.1016/j.injury.2005.05.021. 2015 Jun;114(1):95-111 The treatment of avulsion fractures of the tibial tuberosity in adolescent athletes. The treatment recommended for these patients is excision of the fissure, transverse drilling at the fissure site, and cancellous bone grafting of the defect. Sports Med. 22. 11. 0000001579 00000 n 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. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. eCollection 2022 Oct. Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0. Lower Extremity Stress Fractures in the National Basketball Association, 2013-2014 Through 2018-2019. With this technique, union at the fracture site was achieved and the athlete returned to play football, 6-months postoperatively. Markolf KL, Cheung E, Joshi NB, Boguszewski DV, Petrigliano FA, McAllister DR. This site needs JavaScript to work properly. The tibia is much thicker than the fibula. Results: The site is secure. Statistical analysis was performed using IBM SPSS, Version 26 (Chicago, Illinois). Injury. Of course, it is a single case and further studies are needed. The anterior cruciate ligament and the anterior root of the lateral meniscus are attached to a displaced anterolateral fragment. Morash J, Walton DM, Glazebrook M. Ankle arthrodesis versus total ankle arthroplasty. doi: 10.1016/j.injury.2015.10.052. WebAnterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. Another important finding was a lower but not statistically significant rate of arthrodesis in AO 43-C fractures compared with AO 43-B anterior impaction fractures (17.7% vs 19.4%). For information on cookies and how you can disable them visit our Privacy and Cookie Policy. All these may be possible with im nailing too, but require an additional incision over the fracture site. 1987 Jan-Feb;15(1):46-58 For the navicular, surgery provided an earlier return to sport; and when treated conservatively, weightbearing should be avoided. 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 plate was placed over the nail and the fracture healed properly. 2011;93-A:533539. 0000000016 00000 n 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). He was symptom free; he resumed at that time a full training program and he returned to play football 6months postoperatively at his preinjury high competition level. 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. In their study, none of the tibial fractures nailed in the semi-extended position had more than 5 degrees of apex anterior angulation. This injury is derived from excessive tensile forces from posterior muscle activity. Br J Sports Med. [12] A relationship is known to exist between injury severity and patient outcomes (r = 0.3, P = .04), grade of arthrosis (r = 0.4, P < .01), and return to work status. 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]. Management of high-energy tibial pilon fractures. You may search for similar articles that contain these same keywords or you may Study patients underwent external fixation and/or open reduction internal fixation (ORIF) as indicated by fracture/injury pattern. 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. Patient comorbidities (coronary artery disease, hypertension, renal disease, and diabetes) and smoking status were also recorded. 2004;427:S6S15. Accessibility Some error has occurred while processing your request. In our case, a non-united anterior tibial stress fracture, treated with intramedullary nailing, was addressed with the application of a compression prebended plate over the nail in a 23-year-old French man of African origin who is an elite football player. Previous surgery before definitive fixation also seemed to be associated with an increased risk of arthrodesis as shown in Table 1. Unable to load your collection due to an error, Unable to load your delegates due to an error. and transmitted securely. FOIA However, there are unsatisfying outcomes of conservative therapy in the anterior tibia. Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes. Keywords: Articles in PubMed by Moaz B.Y. Surgical procedures varied widely. For the fifth metatarsal fracture, weighted mean return to sport was 19 for conservative and 14 weeks for surgical treatment. [19] Little has been published about the AO/OTA 43-B partial articular fracture. 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. Wolters Kluwer Health, Inc. and/or its subsidiaries. MeSH Hattori H, Ito T. Recurrent fracture after anterior tension band plating with bilateral tibial stress fracture in a basketball player. In a recent multicenter trial published by Sommer et al, 4 radiographic criteria predicted poor outcomes after plafond fractures. Diagnosis can often be Tension band plating of the anterior tibia stress fracture nonunion. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA type 43C). Transverse fractures are more common than vertical ones. official website and that any information you provide is encrypted 0000001301 00000 n Stress fracture is the result of an imbalance between bone formation and bone reabsorption during excessive, repetitive, dynamic cyclic loading. 2017;48:946953. The mean time to fusion for AO 43-A was not available as we did not have any cases with fusion in this fracture pattern. -, Clin Orthop Relat Res. 2005;25:4446. 0000003545 00000 n In those patients who suffer a complete fracture, open reduction and internal fixation is superior to closed treatment. A material testing machine (Mini Bionix 858, MTS Systems Co., Minneapolis, MN, 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. The overall rate of fusion in all 168 patients was 13.1%. [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. Unfortunately, the fracture site did not consolidate again, even 18-months postoperatively, so he presented to our clinic for counseling. Tension band plating offers biomechanical advantages over im nailing [16, 17]. Schilcher J, Bernhardsson M, Aspenberg P. Scand J Med Sci Sports. Tibial spine avulsion fractures represent an avulsion of the tibial eminence at the anterior cruciate ligament (ACL) insertion. eCollection 2019. Pediatr Radiol. The necrotic bone and callus at the fracture site was debrided with the use of an osteotome and a curette. Would you like email updates of new search results? A post-hoc power calculation was performed. Zbeda RM, Sculco PK, Urch EY, et al. Accessibility GAT was also responsible for the patients follow-up. Jacob N, Amin A, Giotakis N, et al. While the rate of arthrodesis was more than 2-fold greater, this was not statistically significant. Before HHS Vulnerability Disclosure, Help These fractures are resistant to non-operative healing due to high tensile load, poor local vascularity, and lack of adequate muscle and soft tissue coverage, which all compromise bone healing. An official website of the United States government. 2016 Oct;47(4):733-41. doi: 10.1016/j.ocl.2016.05.015. 2017;22:251266. The Moreover, delayed union, nonunion, and progression to complete fracture is common with conservative treatment [12]. Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. The plate was prebended and the screws were placed in a compression manner to achieve a tension band effect to the fracture site. For navicular fracture, a weighted mean return to sport of 22 for conservative and 16 weeks for surgical treatment was found. Keyword Highlighting FOIA 8600 Rockville Pike Outcomes after treatment of high energy. 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. 2018;26:640651. This site needs JavaScript to work properly. Open fracture conferred an increased rate of arthrodesis compared to closed fracture (33.3 vs 10.2%, P < .01). Methods: 4 8 Rest has Epub 2015 Mar 31. [912] However, the experience at our institution has been that AO/OTA 43-B fractures with anterior plafond impaction have higher rates of PTOA and the need for subsequent surgical treatment than would be anticipated on the basis of the AO/OTA classification system. Anastasios V. Tokis, Email: rg.oohay@sikotat. The .gov means its official. This study has limitations inherent to its retrospective cohort design. -, Am J Sports Med. Federal government websites often end in .gov or .mil. 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. Thirty-six of these fractures in 35 patients have been reported in the literature. J Arthritis. HHS Vulnerability Disclosure, Help Bookshelf bLondon Health Sciences Center, London, ON, Canada. 10. All rights reserved. 2021. Noticing this, the patient was asked about tibial fractures he had in the past. Transverse drilling around the fracture site was done to promote healing and osteoblastic activity. Anderson DD, Killburg AT. Received 2017 Nov 6; Accepted 2018 May 15. -, Am J Sports Med. official website and that any information you provide is encrypted High-Risk Stress Fractures: Diagnosis and Management. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. sharing sensitive information, make sure youre on a federal Careers. 16. The HSREB is registered with the U.S. Department of Health & Human Services under the IRB registration number IRB 00000940. 0000040539 00000 n -, Am J Sports Med. Please enable it to take advantage of the complete set of features! This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Purpose: Imaging plays a key role in confirming the diagnosis. 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 He was symptom free; he resumed at that time a full training program and he returned to play football at preinjury high competition level. Duckwort AD, Jefferies JG, Clement ND, et al. Epub 2018 Mar 12. Treatment decision-making would greatly benefit from further prospective research. -. (See "Tibial and fibular shaft fractures in children" and "Overview eCollection 2021 Mar 30. (C) Sagittal CT cut of distal tibia. 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. 0000012611 00000 n 2022 Apr 28;8(1):26. doi: 10.1038/s41572-022-00352-y. They are termed high risk due to their predilection to prolonged Intramedullary (im) nailing is the most common modality of treatment. Mclnnis KC, Ramey LN. [1] The rate of PTOA for plafond injuries is higher than that for other injuries to the ankle joint. Orthop Clin North Am. 2007 Mar;456:254-8 Quality of fracture reduction assessed by radiological parameters and its influence on functional results in patients with pilon fractures: a prospective multicentre study. Br Med Bull. These fractures also confer increased risk of progression to arthrodesis. 2021 Mar 1;57(3):223. doi: 10.3390/medicina57030223. The mean follow-up time for AO 43-B Anterior Impaction and Non-Anterior impaction patterns was 11.52 and 13.34 months. government site. 2019 Oct;29(10):1521-1528. doi: 10.1111/sms.13466. The pain got worse when he attempted to walk with full weight bearing, so he had to use crutches. The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Bookshelf Clin Orthop Relat Res. Study participants were identified through billing codes and institutional records of the investigating surgeons. Please try again soon. Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. We used a 6-hole, 4.5mm locking compression plate. J Orthop Case Rep. 2014 Jan-Mar;4(1):39-43. doi: 10.13107/jocr.2250-0685.147. Bethesda, MD 20894, Web Policies 0000037429 00000 n 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. After 6weeks he progressed to weight bearing as tolerated. In the plafond fracture group, AO 43-C fractures have the highest rate of arthrodesis compared with AO-43-A and 43-B fractures. The results of early primary open reduction and internal fixation for treatment of OTA 43-C. J Orthop Trauma. your express consent. For more information, please refer to our Privacy Policy. Patient demographic data and characteristics. Shindle MK, Endo Y, Warren RF, et al. Chi-square analysis was performed for dichotomous data. Poncet first described eminence fractures in 1875. Careers. Tension band plating of an anterior tibial stress fracture nonunion in an elite athlete, initially treated with intramedullary nailing: a case report. and transmitted securely. Avulsion fractures of the lateral tibial condyle in children. Compression plating is a valuable method of treating non-united anterior tibial stress fractures. 0000008987 00000 n He did not smoke tobacco and he had a free medical history. Thordarson DB. [12] It stands to reason that external fixation, and open fractures may be associated with an increased risk of developing PTOA. 8600 Rockville Pike The fascia over the tibialis anterior was divided, the muscle lifted off and the fracture site was visualized. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. Postoperatively, our patient was advised to wear an orthotic boot and to not bear weight for 6weeks. E-mail: address: [emailprotected] (D. W. Sanders). WebAnterior tibia cortex consists a less common location stress fractures. J Bone Miner Res. With the use of locking and non-locking screws we minimized the pressure at the periosteum, which can damage blood supply to the poorly vascularized bone. Study registration number: Tibia and fibula fractures are characterized as either low-energy or high-energy. 0000043955 00000 n Anterior tibial stress fractures are difficult to manage. Vasileiou D, Hadjimichael AC, Kakavelakis K, Panagiotou A, Zafeiris C, Chronopoulos E. Cureus. 1). Buckling of the anterior tibial cortex, best seen on the lateral projection Case Discussion Torus or " buckle " fractures commonly occur following trauma in the distal long bones of children at the point of least resistance between the diaphysis and metaphysis of the developing bone as it buckles under the force of an increased axial load. 2010;24:1000. Accessibility WebAim: To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. 2015;3(10) 10.1177/2325967115610069. Stress fractures were first described in 1855 [3]. 18. PMC 2014;3:15. Mean (median) time to fusion for AO 43-B and 43-C was 8.9 (8) and 16 (5) months. [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. There is further minimally displaced osteochondral fragment of the adjacent inner margin of the medial tibial plateau. It provides compression at the tension side of the tibial cortex and counteracts tensile forces from the posterior muscle group. Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes. Anterior tibial cortex fractures are less common, approximately 2.7 to 4.6% of stress fractures . 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. Sports Med. Chang PS, Harris RM. Knee Surg Sports Traumatol Arthrosc. 2022 Oct 21;14(10):e30537. 1. Learn more Range of motion exercise involving knee and ankle and isometric exercises were initiated immediately postoperatively. Federal government websites often end in .gov or .mil. Expedited CT-based methods for evaluating fracture severity to assess risk of post-traumatic osteoarthritis after articular fractures. Anterior cortex; Magnetic resonance imaging; Stress fracture; Tibia. Nat Rev Dis Primers. Case report: ischial stress fracture non-union in a college football player. Harris AM, Patterson BM. GAT and CGP conceived the idea of treating the patient with the use of tension band plating, while retaining the im nail. 1988 May-Jun;16(3):250-5 Focal or local tenderness at the posteriormedial margin of the tibia near the middle and distal Plate versus intramedullary nail fixation of anterior tibial stress fractures: a biomechanical study. 2018 Aug 8;5(3):312-318. doi: 10.1093/jhps/hny019. 27 0 obj <> endobj This manuscript was written by GAT and CGP. Bone stress injuries of the leg in athletes. Bone Joint J. High union rates following surgical treatment of proximal fifth metatarsal stress fractures. Conservative treatment resulted in high complication rates and few cases returned to sport. Anteroposterior and lateral X-ray of the tibia, 18months after intramedullary nailing. eCollection 2022 Oct. Rizzi AM, Baker HP, Lee CS, Athiviraham A. Orthop J Sports Med. The question remains whether these fractures have an equally poor outcome. 0 FOIA 2016 Jun;45(6):843-6 The authors have no conflict of interests to declare. 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. An official website of the United States government. 0000007690 00000 n 77% complained of pain, and 70% complained of swelling. Corresponding author. The reduction may additionally be secured by temporary K-wires. This article, like our present study, found worse outcomes in fractures with anterior talar shift as we noted with anterior impaction fractures.[22]. 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). Br Med Bull. Intramedullary Nailing of Concurrent Bilateral Tibial Stress Fractures Followed by Unilateral Tension Plating for a Nonunion in a Vitamin D-Deficient Elite Football Player. Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures-A Narrative Review. We Demographic data and imaging were accessed through institutional chart review. Ideally, 143 patients in each group might have given a statistically significant difference. 2016;98-B:11061111. An official website of the United States government. Front Sports Act Living. The tibia is a larger bone on the inside, and the fibula is a smaller bone on the outside. 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 Outcome of ankle arthrodesis and ankle prosthesis: a review of the current status. By continuing to use this website you are giving consent to cookies being used. A A triplanar osteotomy (6.5 cm in height with a width of 1.5 cm) was created on the medial cortex of the proximal tibia along the 3 sides (proximal, distal, and lateral) of the rectangle; the medial margin of the tibia was used as the medial side of the rectangle.BD 2 curved skin incisions Accessibility Please enable scripts and reload this page. Impaction fractures of the anterior tibial plafond: Outcomes after fractures around the ankle: Is the anterior impaction plafond fracture a problem? Two reviewers independently extracted data and assessed methodological quality. No medical comorbidities (hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease) had a statistically significant influence on the rate of ankle arthrodesis. Taking a holistic approach to managing difficult stress fractures. 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. Bookshelf The site is secure. eCollection 2015 Oct. (A) Sagittal computed tomography (CT) cut of distal tibia and ankle. When non-operative treatment fails, the optimal surgical treatment is controversial. 15. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report. J Bone Joint Surg Am. Feldman JJ, Bowman EN, Phillips BB, Weinlein JC. 27 34 Initially, he was treated conservatively. 60 0 obj<>stream Epub 2015 Nov 10. Immediately postoperative lateral view. Biomechanical mechanisms: resolving the apparent conundrum of why individuals with type II diabetes show increased fracture incidence despite having normal BMD. 2010 May;38(5):1048-53. doi: 10.1177/0363546509355408. The union of the fracture is evident in this 6-month postoperative anteroposterior view, Tension band plating of the anterior tibia stress fracture nonunion. Leg pain in athletes is a very common condition. MeSH impaction; OTA 43-B fractures; OTA 43-C fractures; outcome; tibial plafond fractures. Pollak AN, McCarthy MA, Bess RS. 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. We describe the outcome of treatment using 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. Would you like email updates of new search results? Merriman JA, Villacis D, Kephart CJ, Rick Hatch GF. 9. Korkmaz A, Ciftdemir M, Ozcan M, et al. [12] This outcome can partly be explained by extensive intra-articular involvement which accelerates chondrocyte death in the damaged joint. Effect of low-intensity pulsed ultrasound treatment for delayed and non-union stress fractures of the anterior mid-tibia in five athletes. 0000003843 00000 n 8600 Rockville Pike National Library of Medicine Tenderness to the anteriolateral margin of the midshaft would be suspicious for anterior cortex fracture. In group 4, no avulsion fracture was created. ^,-:fCp,~ (db)Gi&B*i EE. may email you for journal alerts and information, but is committed 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. PROSPERO database of systematic reviews: CRD42013004201. -, J Bone Joint Surg Am. -, Am J Sports Med. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1990 May;9(5):311-6. doi: 10.2165/00007256-199009050-00005. Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes: a report of 4 cases. Before [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. White TO, Guy P, Cooke CJ. 19. The tibia is the most common site for developing a stress fracture. Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention. 2013;44:12701274. 2013 Sep;118(6):1034-44. doi: 10.1007/s11547-013-0951-x. Epub 2017 Mar 25. Chohan, Moaz B.Y. <]>> 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. Anterior tibial cortex fractures are less common, approximately 2.7 to 4.6% of stress fractures [8]. We postulate that this may be related to the subset of AO 43-B fractures of interest in this study, specifically, anterior impaction fractures. MRI of tibial stress fractures: relationship between Fredericson classification and time to recovery in pediatric athletes. J Bone Joint Surg Am. [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. WebAnterior-posterior and lateral radiographs of the left lower extremity. Anterior tension band plating for anterior tibial stress fractures in high-performance athletes: a report of 4 cases. 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. Please enable it to take advantage of the complete set of features! The https:// ensures that you are connecting to the Smoking did not confer any increased risk of arthrodesis as well. Moreover, the anterior superior iliac spine often has better vascularization than the anterior tibia, which decreases the risk of pin-site infection. When conservative treatment fails, intramedullary nailing is the mainstay of treatment. Duckworth AD, Jefferies JG, Clement ND, et al. Table 1 contains patient characteristics and arthrodesis data. J Orthop Trauma. 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