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

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

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

Posted on Jan 11, 2014 in Jan – Mar 2014, Volume 4 Issue 1

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 35-38 | 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.

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