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Surgery for tibial stress fractures in elite dancers, case series

PainSci » bibliography » Miyamoto et al 2009
Tags: surgery, shin pain, treatment, leg, limbs, pain problems, overuse injury, injury, running, exercise, self-treatment

One article on PainSci cites Miyamoto 2009: Shin Splints Treatment, The Complete Guide

PainSci commentary on Miyamoto 2009: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Between 1992 and 2006, seventeen hundred dancers were evaluated at a dance medicine clinic; only 24 of them had stress fractures (quite low), and conservative therapy failed in only 7 cases. Those dancers were operated on: their fractures were stabilized with “drilling and bone grafting or intramedullary nailing” — good old carpentry-style surgery! They did well — shins that had previously refused to knit finally knitted. Recovery was slow but steady in all cases, and they were all dancing normally again by about the six-month mark.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers.

HYPOTHESIS: Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed.

RESULTS: The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively.

CONCLUSION: Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

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