Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report

 

What to Learn from this Article?

A rare presentation of bilateral tibia stress fracture in young female: diagnostic and management challenges.


Case Report |  Volume 4 | Issue 1 | JOCR Jan-Mar 2014 | Page 39-43 | Dailey SK, Archdeacon MT

DOI: 10.13107/jocr.2250-0685.147


Authors: Dailey SK[1], Archdeacon MT[1]

Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212.

Address of Correspondence:

Dr. Steven Dailey, University of Cincinnati, Dept of Orthopaedic Surgery, 231 Albert Sabin Way, ML 212 Cincinnati, OH 45267-0212.t (513) 558-1109 / f (513) 558-2220. Email: steven.dailey@uc.edu


Abstract

Introduction: Stress fractures are overuse injuries most commonly seen in athletes, military recruits, and individuals with endocrine abnormalities. It has been demonstrated that chronic cases of anterior tibial stress fractures refractory to conservative management respond well to intramedullary nailing. To our knowledge, only one report has been published concerning patients with bilateral tibial stress fractures treated with bilateral intramedullary nailing. All patients in the series were high-level athletes. We present the case of a non-athletic patient with chronic bilateral tibial stress fractures and associated deformity successfully treated with bilateral intramedullary nails.

Case Report: A 23-year-old Caucasian female full-time student presented with chronic bilateral shin pain for approximately five years. She had failed an extensive regimen of conservative management. She was diagnosed with chronic bilateral tibial stress fractures based on history, physical examination, and radiologic findings. She subsequently underwent sequential intramedullary nailing of her tibiae. Both tibiae were in valgus alignment; however, this did not preclude nail placement. The nails deformed upon insertion into the sclerotic canals to conform to the deformation. Post operatively the tibiae united and patient was relieved of her symptoms.

Conclusion: Bilateral intramedullary nailing of chronic bilateral tibial stress fractures should be considered as a treatment option for all patients, not just high-level athletes, who fail a trial of conservative management.  Additionally, mild to moderate tibial malalignment does not necessarily preclude tibial nailing as the smaller nails placed in sclerotic canals will likely deform on insertion and conform to the canal.

Keywords: Bilateral intramedullary nailing, bilateral tibial stress fractures, valgus.


 

How to Cite This Article: Dailey SK, Archdeacon MT. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report. Journal of Orthopaedic Case Reports 2014 Jan-Mar ;4(1): 39-43. Available from: http://www.jocr.co.in/wp/2014/01/11/2250-0685-147-fulltext/


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