title: Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.
abstract: 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.
  
  
  OBJECTIVE
  Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Steadman-Hawkins Clinic, 181 W. Meadow Drive, Suite 400, Vail, CO 81657, USA. ryangmiyamoto@gmail.com
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Miyamoto
authors.forename: Herman S
authors.initials: HS
authors.lastname: Dhotar
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Rose
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egol
mesh_terms: D000293:Adolescent; D000328:Adult; D003615:Dancing / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D015775:Fractures, Stress / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D010148:Intractable Pain / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D013977:Tibia / Q000293:injuries*; D055815:Young Adult