A 20-year-old competitive track and field athlete at the collegiate level was referred to the care of David L. Helfet, MD at the Orthopedic Trauma Service of Hospital for Special Surgery following an 18 month history of insidious onset of right-sided shin pain. Her symptoms were aggravated by activity, especially the long jump. One year earlier she had been diagnosed with a stress fracture of her tibia and treated with a bone stimulator and physiotherapy modalities, including ultrasound. She had also tried a short period of immobilization in a CAM walker boot. Following this treatment she had only temporary improvement in her symptoms and was referred to us. At the time of presentation, she was experiencing significant right shin pain that was preventing her from competing in track and field events. Radiographs revealed a radiolucent line involving the anterior cortex of her tibia at the mid-shaft level. She was surgically treated using an anterior tension band construct with placement of bone graft and a locking plate and screws. At 10 weeks follow up her radiographs illustrated healing of the stress fracture and she resumed full activities. At 4 months postoperatively she had resumed training for competition. At 1 year follow-up she was completely asymptomatic.
Anteroposterior and lateral radiographs reveal a stress fracture of the anterior tibial cortex (arrows).
Anteroposterior and lateral radiographs (left images) 8 months following surgery revealing a healed tibia stress fracture and CT scan images (right images) at 8 months illustrate a healed tibial stress fracture.