Blackwell Publishing Journal Backfiles 1879-2005
The natural course of 46 stress fractures of the tibia were studied in relation to sports activity, diagnosis and treatment in 28 recreational athletes and 13 elite athletes. Two major types of stress fractures were observed. Thirty athletes sustained a posteriomedial fracture of the tibia and claimed a sudden onset of exertional pain. The initial symptoms occurred during running or orienteering (n= 19), soccer (n= 4), workout or dancing (n= 3), triathlon, basketball, badminton and tennis (one each) and were similarity distributed between left and right leg. Scintigraphs showed Zwas type I/II lesions, while X-rays were negative in most cases. The patients were treated only with restriction in sports activities. The fractures healed within 8–24 weeks with excellent or good results. The remaining 11 athletes had anterior margin stress fractures with a slow onset of exertional pain and a long delay in diagnosis. These injuries occurred in 4 long-distance runners, 2 handball players, 2 dancers, 1 volleyball player, 1 triathloner and 1 decathloner. They were located in the nondominant left leg (in three cases bilateral). The fractures showed Zwas I or II lesions on scintigrams, but differed from the posteriomedial injuries on the typical V-shape appearence on X-ray. The patients had conservative treatment, including immobility and restriction in sports activities. Four of the patients were operated when not symptom-free after 12–34 months. All elite athletes (n= 5) in this group had to interrupt then-elite carreer. At follow up 24–60 months after the initial symptoms, only 1 patient was symptom-free. Thus, posteriomedial tibial stress fractures show a sudden onset and benign natural course, while anterior stress fractures should be treated with caution. The use of bone scintigraphy should be emphasized early when an athlete presents with exertional lower leg pain.
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