A 15-year-old female, avid soccer and volleyball player, noted progressive onset of right-sided shin pain during her athletic training over the course of several weeks. Radiographs taken at a local hospital revealed a minimally displaced mid-shaft tibia stress fracture. She was initially treated with cast immobilization for 3 months. She was referred to Dr. David L. Helfet at the Orthopedic Trauma Service at Hospital for Special Surgery at 6 months for definitive management of a malunion with bridging callus on the lateral cortex and with 13° of valgus deformity. Operative treatment was planned and performed including correction of the deformity and insertion of an intramedullary (IM) nail and locking screws. She returned for regular follow-up visits and at 3 months following surgery she had excellent radiographic and clinical results including a healed tibia fracture, resolution of pain and full range of motion of the knee and ankle joints. She returned to all pre-injury activities at 4 months. At 1 year following surgery the hardware was removed.
Anteroposterior (AP) and lateral radiographs (left images) reveal a minimally displaced mid-shaft tibia stress fracture. AP and lateral radiographs at 6 months following the injury (right images) illustrating a malunion with 13° of valgus deformity.
Anteroposterior and lateral radiographs 6 months following surgery (left images) illustrating a healed tibial malunion in acceptable alignment. Intraoperative fluoroscopic images (right images) following removal of hardware at 12 months.