title: Return to Sport Following Surgery for a Complicated Tibia and Fibula Fracture in a Collegiate Women's Soccer Player with a Low Level of Kinesiophobia.
abstract: OBJECTIVE
  Much attention has been solely paid to physical outcome measures for return to sport after injury in the past. However, current research shows that the psychological component of these injuries can be more predictive of return to sport than physical outcome measures. The purpose of this case report is to describe the successful return to sport following surgery of a complicated tibia and fibula fracture of a Division I collegiate women's soccer player with a low level of kinesiophobia.
  
  
  METHODS
  A 22-year-old female sustained a closed traumatic mid-shaft fracture of her tibia and fibula. During a high velocity play she sustained a direct blow while colliding with an opposing player's cleats. As a result of the play, her distal tibia was displaced 908 to the rest of her leg. She underwent a closed reduction and tibial internal fixation with an intramedullary rod. Outcome scores were tracked using the IKDC and TSK-11. The IKDC measures symptoms, function, and sport activity related to knee injuries. The TSK-11 measures fear of movement and re-injury, which was important to assess during this case due to the gruesome nature of the injury.
  
  
  RESULTS
  At 4 months, the subject became symptomatic over the fibula and was diagnosed with a fibular nonunion fracture. This was unexpected due to the low incidence of and usual asymptomatic nature of fibular nonunion fractures, which required an additional surgery. TSK-11 scores ranged from 19-20 throughout, signifying low levels of kinesiophobia. IKDC scores improved from 8.05 to 60.92. The subject ultimately signed a professional soccer contract.
  
  
  CONCLUSIONS
  The rehabilitation of this subject was complex due to her low levels of kinesiophobia, self-guided overtraining, and the potential role they may have had in her fibular nonunion fracture. This case study demonstrates a successful outcome despite a unique injury presentation, multiple surgeries, and low levels of kinesiophobia. While a low level of kinesiophobia can be detrimental to rehabilitation compliance, it may have benefited her in the long-term.
  
  
  METHODS
  5.
authors.affiliation: UHealth Sports Performance and Wellness Institute, University of Miami (FL), Miller School of Medicine, Miami, FL, USA.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Feigenbaum
authors.affiliation: UHealth Sports Performance and Wellness Institute, University of Miami (FL), Miller School of Medicine, Miami, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Baraga
authors.affiliation: UHealth Sports Performance and Wellness Institute, University of Miami (FL), Miller School of Medicine, Miami, FL, USA.
authors.forename: Lee D
authors.initials: LD
authors.lastname: Kaplan
authors.affiliation: Department of Physical Therapy, University of Miami (FL), Miller School of Medicine, Coral Gables, FL, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Roach
authors.affiliation: Department of Physical Therapy, University of Miami (FL), Miller School of Medicine, Coral Gables, FL, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Calpino
authors.affiliation: Department of Physical Therapy, University of Miami (FL), Miller School of Medicine, Coral Gables, FL, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Dorsey
authors.affiliation: Department of Physical Therapy, University of Miami (FL), Miller School of Medicine, Coral Gables, FL, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Martorelli
authors.affiliation: Department of Physical Therapy, University of Miami (FL), Miller School of Medicine, Coral Gables, FL, USA.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Sagarduy
authors.affiliation: Department of Athletics, Athletic Training, University of Miami (FL), Coral Gables, FL, USA.
authors.forename: Lesley-Anne
authors.initials: LA
authors.lastname: King
authors.affiliation: Department of Athletics, Athletic Training, University of Miami (FL), Coral Gables, FL, USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Scavo
keywords: Fracture; kinesiophobia; soccer