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• #X RAY STRESS FRACTURE SHIN TRIAL#

The patient had a normal BMI, with no concerning signs of metabolic or hormonal abnormalities.Īfter obtaining radiographs and a physical exam, the patient was found to have bilateral multiple anterior cortex mid-tibial diaphyseal stress fractures. The mother reported the patient had no dietary concerns but could be eating healthier. She is otherwise healthy with menarche at age 11 and reported normal cycles. She denied prior history of stress fractures, multiple previous fractures, and a family history of bone diseases, such as osteogenesis imperfecta. Initially, her pain only occurred with sports-related activities however, after a recent 3-day volleyball tournament, her pain acutely worsened, yet improved with rest. She normally trains 6 h per day and 4 days per week. Case ReportĪ 16 year and 7-month-old African American female, who participates in multiple sports including cheer, softball, and competitive volleyball, presents with 5 months of worsening atraumatic bilateral anterior leg pain. In place, verbal consent from the patient and guardian were obtained for the publication of the case report. Written informed consent for the publication of this case report was waived by the University of Texas Southwestern Medical Center Institutional Review Board. Currently, no specific guidelines for managing anterior tibial diaphyseal stress fractures exist, and these must be treated on a case-by-case basis.

Current surgical options include IM nailing, tension band plating, and techniques, such as drilling and debridement of the fracture site with bone grafting ( 1, 4– 6). One benefit of early surgical intervention is a faster return to sport, with a mean timeline of 4 months ( 3) compared to 6–12 months with conservative management. The physician must take into consideration the characteristics of the stress fracture as well as the athlete's level of sport and athletic timeline. Consideration for investigation into the etiology of stress fracture beyond activity is needed in atypical presentations.

#X RAY STRESS FRACTURE SHIN TRIAL#

Although a trial of conservative management is initially recommended, early surgical intervention may be considered in patients with risk factors associated with delayed healing (i.e., metabolic or nutritional concerns). These injuries can appear as the “dreaded black line” over the anterior tibial cortex however, plain radiographs have been shown to have a low sensitivity (10–50%) for detecting stress fractures, particularly if presented early on in the clinical course ( 2). In athletes who may want to return to sport rapidly, early operative intervention and correction of vitamin D deficiency may be treatment options.Īnterior tibial diaphyseal stress fractures are commonly seen in runners and dancers and are considered “high risk” stress fractures due to prolonged healing ( 1). She was treated with a combination of vitamin D supplements and static intramedullary nailing of the bilateral tibias resulting in clinical and radiographic healing and return to sports.ĭiscussion: Vitamin D deficiency and high level of activity in a young athlete may be the etiology to atypical multiple stress fractures. Multiple bilateral anterior tibial diaphyseal stress fractures and significant vitamin D deficiency were identified.