II. Epidemiology
- Most common Stress Fracture
- Accounts for >50% of Stress Fractures
- Common overuse injury in runners and jumpers
- Mid-tibial shaft Stress Fractures
- Occur in dancers
- Occur in jumping athletes
III. Risk Factors
IV. Differential Diagnosis
V. Symptoms and signs suggestive of Tibial Stress Fracture
- Nocturnal pain
- Extremely painful focal area of tibia
- Provocative maneuvers
- Pain on application of vibrating tuning fork
- Pain elicited on heel thump or "Hop Test"
- Pain with local Ultrasound at 2.5 to 3 W/cm2
- Not recommended currently for initial diagnosis
- Boam (1996) J Am Board Fam Pract 9:414-7 [PubMed]
- Common locations of Stress Fracture
- Children: Anterior proximal one third of tibia
- Adults: Junction of middle and distal third of tibia
VI. Diagnostics
- XRay with cone down view
- Horizontal lucency (Dreaded Black Line)
- Transverse Fracture through entire anterior shaft
- Seen more often in jumping sports
- Higher likelihood of nonunion
- Horizontal lucency (Dreaded Black Line)
- Triple phase bone scan
- Focal hot spot at point of maximal tenderness
- Magnetic Resonance Imaging (MRI) Tibia
VII. Management
- See Stress Fracture
- Activity
- Avoid Running for 6-8 weeks
- May weight bear unless painful
- Slow, graded return to activity
- Return to sport may be as long as 3-10 months
- Other measures
VIII. Prognosis
- Anterior Fracture with more non-union than anteromedial