title: Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes.
abstract: BACKGROUND
  Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures.
  
  
  OBJECTIVE
  Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition.
  
  
  RESULTS
  Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion.
  
  
  CONCLUSIONS
  Anterior tension band plating for chronic tibial stress fractures provides a reliable alternative to intramedullary nailing with excellent results. Compression plating avoids the anterior knee pain associated with intramedullary nailing but may result in symptomatic hardware requiring subsequent removal.
authors.affiliation: New York Medical College, Valhalla, New York, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Zbeda
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Sculco
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Ekaterina Y
authors.initials: EY
authors.lastname: Urch
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.affiliation: University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Wellman
authors.affiliation: Hospital for Special Surgery, New York, New York, USA helfetd@hss.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
mesh_terms: D000328:Adult; D056352:Athletes; D001490:Basketball / Q000293:injuries; D001860:Bone Plates; D003615:Dancing / Q000293:injuries; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D015775:Fractures, Stress / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D008297:Male; D010146:Pain / Q000209:etiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D054798:Volleyball / Q000293:injuries; D055815:Young Adult
keywords: anterior; stress fractures; tension band plating; tibia