Dailey Steven K, Archdeacon Michael T
Department of Orthopaedic Surgery, University of Cincinnati, PO Box 670212, Cincinnati, OH 45267-0212.
J Orthop Case Rep. 2014 Jan-Mar;4(1):39-43. doi: 10.13107/jocr.2250-0685.147.
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.
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.
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.
应力性骨折是一种过度使用导致的损伤，最常见于运动员、新兵以及内分泌异常的个体。已有研究表明，对于保守治疗无效的慢性胫骨前侧应力性骨折病例，髓内钉固定治疗效果良好。据我们所知，仅有一篇关于双侧胫骨应力性骨折患者接受双侧髓内钉固定治疗的报告发表。该系列中的所有患者均为高水平运动员。我们在此报告一例非运动员患者，其慢性双侧胫骨应力性骨折及相关畸形通过双侧髓内钉成功治愈。
一名23岁的白人女性全日制学生，因双侧胫骨慢性疼痛约五年前来就诊。她接受了广泛的保守治疗方案，但均告失败。根据病史、体格检查及影像学检查结果，她被诊断为慢性双侧胫骨应力性骨折。随后她接受了双侧胫骨的序贯髓内钉固定治疗。双侧胫骨均呈外翻畸形；然而，这并不妨碍髓内钉的置入。髓内钉插入硬化髓腔时发生变形以适应畸形。术后胫骨愈合，患者症状缓解。
对于所有经保守治疗无效的患者，而非仅针对高水平运动员，双侧慢性胫骨应力性骨折的双侧髓内钉固定应被视为一种治疗选择。此外，轻度至中度的胫骨畸形并不一定排除胫骨钉固定，因为置于硬化髓腔内的较细髓内钉在插入时可能会变形并与髓腔相适应。
