Review Question - QID 494

Tibial stress fractures are relatively common overuse injuries that can often be difficult to treat. Differential includes medial tibia stress syndrome (shin splints), periostitis, infection, bursitis, neoplasm, exertional compartment syndrome, or nerve entrapment. Other comorbid medical conditions, including the female athlete triad, need to be carefully evaluated and treated. As Young describes, nonoperative treatment with protected weightbearing is the standard, but surgical intervention may be necessary if symptoms are not responsive to initial nonoperative treatment. For shaft fractures, intramedullary nailing may allow return to sport but does not guarantee healing. Plain radiographs are usually normal early on but with time may show periosteal reaction, new bone formation, or even a distinct fracture line. The typical posteromedial stress fracture is considered lower risk, whereas the anterior or “dreaded black line” stress fractures are considered higher risk. Ishibashi showed that MRI was better than bone scan for evaluating these injuries.