Zbeda Robert M, Sculco Peter K, Urch Ekaterina Y, Lazaro Lionel E, Borens Olivier, Williams Riley J, Lorich Dean G, Wellman David S, Helfet David L
New York Medical College, Valhalla, New York, USA.
Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2015 Jul;43(7):1712-8. doi: 10.1177/0363546515577355. Epub 2015 Mar 31.
Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures.
Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing.
Case series; Level of evidence, 4.
Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition.
Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion.
Anterior tension band plating for chronic tibial stress fractures provides a reliable alternative to intramedullary nailing with excellent results. Compression plating avoids the anterior knee pain associated with intramedullary nailing but may result in symptomatic hardware requiring subsequent removal.
胫骨前侧应力性骨折的骨不连和延迟愈合发生率较高，这对于需要迅速恢复比赛的职业运动员来说可能是灾难性的。目前的手术治疗策略包括髓内钉固定，其骨折愈合率令人满意，但存在前膝疼痛的风险。胫骨前侧张力带钢板固定是治疗这些骨折的一种生物力学合理的替代方法。
慢性胫骨前侧应力性骨折采用张力带钢板固定可实现快速愈合并恢复体育活动，且可避免髓内钉固定相关的前膝疼痛。
病例系列；证据等级，4级。
2001年至2013年期间，12名职业或大学运动员发生了13例慢性胫骨前侧应力性骨折，在非手术治疗失败后接受了张力带钢板固定。对患者病历进行回顾性分析，以获取人口统计学资料、损伤史和手术细节。通过X线片评估骨愈合时间。通过随访记录和电话访谈确定随访时间、恢复训练时间以及患者是否能够恢复比赛。
病例包括12例患者的13例应力性骨折（9例女性，3例男性）。5例为田径运动员，4例打篮球，2例打排球，1例为芭蕾舞演员。5例为一级大学运动员，7例为职业或奥运会运动员。手术时的平均年龄为23.6岁（范围20 - 32岁）。术后平均9.6周（范围5.3 - 16.9周）实现骨愈合。患者平均11.1周（范围5.7 - 20周）恢复训练。92%（12/13）最终恢复到受伤前的比赛水平。38%（5/13）因钢板突出接受了内固定取出术。无感染或骨不连发生。
慢性胫骨应力性骨折采用胫骨前侧张力带钢板固定是髓内钉固定的可靠替代方法，效果良好。加压钢板固定可避免髓内钉固定相关的前膝疼痛，但可能导致内固定物出现症状而需要后续取出。
