tibial stress fracture

  • related: MSK

  • pt: vigorous running regimen, runners, ballet dancers, military recruits, soccer/basketball players

  • cause: increase in tension/compression without adequate rest

  • sx:

    • lower leg pain, tibial tenderness
    • initial: medial tibial stress syndrome (shin splints), no tibial tenderness
    • later: fracture, tenderness on palpation

  • diagnosis:

    • pain at area of stress, local swelling
    • x ray tibia low sensitivity, neg first 4 weeks
    • positive xray findings: bone sclerosis, cortical thickening, periosteal elevation, and visible fracture line
    • MRI for definitive diagnosis, may be abn up to 1 year after healing

  • rx

    • treat empirically: conservative treatment, pneumatic splinting, reduce weight bearing, graduated exercise
    • crutches for first 1-2 weeks

Supplementation is controversial:

Calcium and vitamin D supplementation is recommended by some experts for patients with tibial stress fractures, especially those with inadequate dietary intake or deficient serum vitamin D levels. Tibial stress fractures can be seen in female athletes with low caloric intake, low bone density, and hypomenorrhea or amenorrhea, but typically present with localized pain and point tenderness.

Calcium and vitamin D supplementation in postmenopausal women reduces the rate of bone loss, and may decrease the risk of osteoporotic fracture. However, there is currently no evidence that calcium and vitamin D supplementation accelerates healing or reduces the risk of stress fractures in younger patients without osteoporosis.