Tibial Stress Fractures

EpidemiologyTibial Stress Fracture


Athletic / high impact exercises




First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes




Point tenderness

- lateral aspect of tibia


Over time develop bony lump


X- ray


Often narrow medullary canal & thickened periosteum

- proximal third in adolescents

- runners typically at junction of middle and distal 1/3 


Tibial Stress FractureTibial Stress Fracture 2


Dreaded black line / fracture


Tibial Stress Fracture




Posteromedial Tibial Stress Fracture


On compression side

Better prognosis for healing


Posteromedial Tibial Stress Fracture




Granulation tissue, fibrous vascular periosteum, underlying new bone formation




Osteoid Osteoma


Osteogenesis Imperfecta






Can take a long time to heal

- up to 1 year


Can fracture

- which can go on to non union




Non operative Management




PTB / Rest




Operative Management




Bone graft

Percutaneous drilling


Anterior Plating


IM Nail


Chang et al 1996 Am J Sports Med

- five cases of chronic tibial stress fractures

- army recruits with minimum 1 year non-op treatment

- reamed IM nail

- 3 proximally locked, 2 percutaneous corticotomies

- 1 lost to follow up

- 2 excellent results (unlimited pain free running)

- 3 good results (occasional pain with vigorous exercise)

- conclusions: safe, effective / no need to lock proximally / corticotomy not needed


Varner et al Am J Sports Med 2005

- 7 athletes treated with IM reamed nail

- united by 3 months

- return to sport by 4 months

- one patient developed bursitis at nail insertion site which settled with HCLA

- one patient developed a distal tibial traumatic fracture which healed non operatively


Anterior Plating


Borens et al J Orthop Trauma 2006

- 4 world class female athletes

- treated with anterior tension band plate

- no complications

- all healed and return to full sports at 10 weeks