Intramedullary nailing for chronic tibial stress fractures - A review of five cases

Chronic tibial stress fracture is an unusual condition that is primarily seen in athletes and military personnel. Recurrent or recalcitrant stress fractures can be career-ending because they require lengthy nonoperative treatment. We performed a retrospective review of five patients who underwent intramedullary tibial nailing for recalcitrant stress fractures at Womack Army Medical Center, Ft. Bragg, North Carolina, from 1991 to 1994. Interviews were used to survey the patient's history and outcome. We reviewed each case regarding preoperative symptoms, preoperative treatment, surgery performed, radiographic findings, and functional outcome. In each case there were several similarities in symptoms and, most notably, radiographic findings and failure of nonoperative therapy for more than 1 year. Each patient had an unusually narrow medullary canal, a thickened anterior cortex, and a linear unicortical fracture line on the anterior or tension side. Although functional results varied, all patients reported improvement in their symptoms and could return to limited running. There were two excellent results (defined as unlimited pain-free running and resolved tibial pain) and three good results. We believe intramedullary tibial nailing should be considered for treating chronic stress fractures of the midanterior tibia that are recalcitrant to nonoperative therapy in a selected group of patients.