Tibial Stress Fracture (Shin Splints)

Epidemiology

• Most common Stress Fracture
  • Accounts for >50% of Stress Fractures
• Common overuse injury in runners & jumpers
• Mid-tibial shaftStress Fractures
  • Occur in dancers
  • Occur in jumping athletes

Differential Diagnosis

• Shin Splints
• Exertional Compartment Syndrome

History

• Nocturnal pain

Examination

• Extremely painful focal area of tibia
• Provocative maneuvers
  • Pain on application of vibrating tuning fork
  • Pain elicited on heel thump or >Hop Test”
  • Pain with local ultrasound at 2.5 to 3 W/cm2
    • Not recommended currently for initial diagnosis
• Common locations of Stress Fracture
  • Children: Anterior proximal one third of tibia
  • Adults: Junction of middle & distal third of tibia

Investigations

• XRay with cone down view
  • Horizontal lucency (dreaded black line)
    • Transverse fracture through entire anterior shaft
    • Seen more often in jumping sports
    • Higher likelihood of nonunion
• Triple phase bone scan
  • Focal hot spot at point of maximal tenderness
• Magnetic Resonance Imaging (MRI)

Management

• Consider Aircast splinting
• Cast mid-shaft fractures until pain-free
• Surgical repair indicated for delayed healing >6 months

Prognosis

• Anterior fracture with more non-union than anteromedial