Tibial Stress Fracture 733.93

synonyms:

Tibial Stress Fx ICD-9

• 733.93

Tibial Stress Fx Etiology / Epidemiology / Natural History

• A 'normal response to abnormal stress' described as a biomechanical failure of bone under repetitive, nonviolent stress.  A microfracture occurs which progresses to a stress fracture with continued stress.
• recent increase in running speed, shoe or track error is common. 
• Eating disorders and menstrual irregularities have been associated with stress fractures. 
• usually describe localized pain which is relieved by rest.  Pain continues to occur earlier in the training course with continued exercise. 
• point tenderness on the bone, aggravated by percussion. 

Tibial Stress Fx Anatomy

Tibial Stress Fx Clinical Evaluation

• Female patients should be questioned about disordered eating, and menstrual irregularities. (Nattiv A, Clin Sports Med. 1994;13:405).

Tibial Stress Fx Xray / Diagnositc Tests

• A/P and Lateral of tibia indicated. Vast majority of stress usually occur on posteromedial cortex (compression side), generally transverse in orientation.
• Xray may be normal
• Look for “V”-shaped defect in anterior cortex on lateral view, referred to as “dreaded black line” indicative of anterior cortex stress fx
• Bone Scan: Medial tibial stress syndrome demonstrates diffuse moderate increased activity along posteromedial border of tibia. Stress fractures demonstrate more focal, intense often fusiform reaction. Chronic exertional compartment syndrome has normal bone scan.

Tibial Stress Fx Classification / Treatment

• posteromedial cortex fxs generally respond well to discontinuation of inciting activity.
• anterior cortex of middle 1/3 are predisposed to non-union or delayed union or progression to complete fractures. Trial of rest with or without immobiliation for a minimum of 4-6 weeks.  If xrays reveal chronic changes such as a wide fissure, surgical intervention is indicated.
• AOSSM Stress Fracture patient information
• Surgery = reamed unlocked IM nail. (Chang PS, Am J Sports Med 1996;24:688-692)

Tibial Stress Fx Associated Injuries / Differential Diagnosis

• Infection
• Tumor
• Medial tibial stress syndrome
• Exertional compartment syndrome

Tibial Stress Fx Complications

Tibial Stress Fx Follow-up Care

Tibial Stress Fx Review References

• Boden BP, JAAOS 2000;8:344-53