Tibial stress fracture managent

Management of patients with non-unions or stress fractures of the tibia or distal femur with debilitating ipsilateral knee arthritis can be difficult to manage. In these examples of care, we present three illustrations of using long stemmed modular total knee components to successfully manage both tibial and femoral non-unions and stress fractures as well as ipsilateral arthritis with resultant deformity. The average improvement in our knee outcome scores for these three patients via pre-operative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) and one-year post-operative KOOS, JR is 44...

Medial collateral ligament (MCL) injuries are typically managed non-operatively, with high rates of clinical success. However, patients who present with medial knee laxity with valgus stress testing of a fully extended knee, anteromedial rotatory instability, associated tibial plateau fracture, or multiligament injury or those who continue to be symptomatic after non-operative treatment may benefit from surgical intervention. Patients with a history of total knee arthroplasty who suffer MCL and posterior oblique ligament (POL) injuries represent a challenging patient population and often require surgical attention...

BACKGROUND: Femoral and tibial stress injuries are commonly found in long distance running athletes. Stress fractures have rarely been reported in athletes performing high intensity interval training (HIIT) exercise. The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises. CASE SUMMARY: A 26 year old female presented with bilateral medial tibial pain...

BACKGROUND: Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal. PURPOSE: To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan)...

BACKGROUND: It is difficult to diagnose and grade bony stress injury (BSI) in the athletic adolescent population without advanced imaging. Radiographs are recommended as a first imaging modality, but have limited sensitivity and, even when findings are present, advanced imaging is often recommended. HYPOTHESIS: It was hypothesized that the significance of radiographs is underestimated for BSI in the adolescent with positive clinical examination and history findings...

Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches. It is usually underdiagnosed and its aetiology is very diverse. In 20% of cases it is idiopathic. There is no test that diagnoses it with certainty. The diagnosis is usually made by correlating clinical history, imaging tests, nerve conduction studies (NCSs) and electromyography (EMG). A differential diagnosis should be made with plantar fasciitis, lumbosacral radiculopathy (especially S1 radiculopathy), rheumatologic diseases, metatarsal stress fractures and Morton's neuroma...

Genu varum is a common finding in the pediatric population with a large differential, including but not limited to Blount's disease, rickets, and physiologic bowing of the legs. Here we report a case of a 12-year-old Caucasian male who presented for an atraumatic stress fracture of the fifth metatarsal after an athletic event. Further evaluation showed significant genu varum with a Q angle of 9 degrees and medial knee joint space narrowing. The patient was unable to undergo conservative management due to early completion of puberty with relatively premature skeletal maturity...

Tibial cortex transverse transport (TTT) surgery is an extension of the Ilizarov technique. Based on the law of tension-stress, its primary function is to rebuild microcirculation which can relieve ischemic symptoms and promote wound healing. It has received more and more scholars' attention and has experienced a series of changes for 20 years since it entered PR China. The mechanisms involved have gradually become clear, such as the reconstruction of the polarization balance of macrophages, the promotion of vascular tissue regeneration, and the mobilization and regulation of bone marrow-derived stem cells...

Introduction: Anterior fractures of the tibial plateau are either compression or avulsion injuries. Anterior compression fractures of the tibial plateau (ACFT) are rare being traditionally described as involving the rim and often associated with ligament injuries. We have presented 7seven cases of the "large'' type of ACFT, an uncommon pattern of ACFT. Materials and Methods: 7Seven cases of large type ACFTs were identified on retrospectively analyzing the institutional database from 2014 to 2019...

Sesamoid bone disorders are disabling conditions with limited treatment options. This case report describes a 17-year-old football player with avascular necrosis (AVN) in both the tibial and fibular hallux sesamoids with a concomitant non-displaced stress fracture of the tibial hallux sesamoid. After a short period of conservative management, the patient underwent open sesamoid core decompression with an application of concentrated bone marrow aspirate and amnion matrix. After postoperative physical therapy, the patient achieved a painless range of motion of the first metatarsophalangeal joint...

INTRODUCTION: MRI is commonly used to evaluate medial tibial stress syndrome (MTSS), based on grading assessments developed in civilian populations. When MTSS represents stress fracture, rest is required to allow for bone remodelling to occur. False positive evaluations can lead to unnecessary recruit attrition. METHODS: Thirty randomly selected new recruits to a special forces training unit underwent MRI of their tibias using the T2-Dixon sequence at the onset of training...

The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling...

Introduction: Insufficiency fractures are uncommon injuries, but may occur in the lower extremity due to repetitive stress on abnormal bone tissue. Management of these injuries may include weight bearing restrictions, bracing, or even surgical intervention. In addition, a proper metabolic healing environment is required to encourage healthy bone growth following an injury. Case Presentation: This case report discusses a patient who underwent surgical repair of a closed nondisplaced proximal tibia insufficiency fracture...

Background and context: Surgical procedures are evolving toward less invasive and more tailored approaches to consider the specific pathology, morphology, and life habits of a patient. However, these new surgical methods require thorough preoperative planning and an advanced understanding of biomechanical behaviors. In this sense, patient-specific modeling is developing in the form of digital twins to help personalized clinical decision-making. Purpose: This study presents a patient-specific finite element model approach, focusing on tibial plateau fractures, to enhance biomechanical knowledge to optimize surgical trauma procedures and improve decision-making in postoperative management...

BACKGROUND: Inventory management or immediate availability of fracture plates can be problematic since for each surgical intervention a specific plate of varying size and functionality must be ordered. Modularization of the standard monolithic plate is proposed to address this issue. METHODS: The effects of four different unit module design parameters (type, degree of modularization, connector screw diameter, sandwich ratio) on the plate bending stiffness and failure are investigated in a finite element four-point-bending analysis...

OBJECTIVE: Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS: This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries...

INTRODUCTION: On rare occasions, fractures of the tibial plateau may occur after uni-compartmental knee arthroplasty (UKA) and account for 2% of total UKA failures. The purpose of this narrative review is to identify and discuss potential risk factors that might lead to prevention of this invalidating complication. MATERIALS AND METHODS: Electronic database of Pubmed, Scopus, Cochrane and Google Scholar were searched. A total of 457 articles related to the topic were found...

Introduction: Mid-diaphyseal anterior tibial stress fractures can be debilitating injuries. They have been described occurring in athletes due to repetitive lower extremity trauma. The purpose of our study was to highlight a case of an athlete sustaining a tibial stress fracture with multiple cortical defects. Case Report: We present an 18-year-old collegiate bound athlete who sustained a tibial stress fracture with multiple cortical defects. The clinical decision, after failure of conservative treatment, was made to treat the patient with tibial intramedullary nailing...

Athletes fear stress fracture (SF) injuries as they can put a premature end to their athletic careers. Understanding any mechanical constraints can suggest preventive management approach. Specifically, for the triple jump, the mechanical stresses that occur during the event appear to be the main factors for risk of injury. This clinical case describes three successive episodes of anterior tibial fracture in an international triple jumper between 2011 and 2013. The first fracture received surgical treatment involving intramedullary nailing...

BACKGROUND: Low-risk bone stress injuries (BSIs) of the tibia and metatarsal diaphyses account for more than half of BSIs in runners. They interrupt training and are managed using noninvasive approaches that are designed to achieve a speedy but safe return to running. CLINICAL QUESTION: What is the optimal load to manage low-risk tibial and metatarsal BSIs and safely return to running? KEY RESULTS: Optimal load can be guided by knowledge of the BSI healing process and is symptom driven...