Lower Leg Injury in High School Football Player John Hardin, ATC

History This 16 y/o football player had previously fractured tibia and fibula while snowboarding on December 27, 2004 (at age 14).

Snowboarding tib/fib fx 12/04

Signs and Symptoms He received a blow to the anteromedial aspect of distal lower leg while playing in a Friday night football game on September 22, 2006. He was able to bear full weight, however was unable to run and perform functional activities.

History The following Monday, 9/25, he was able to participate in low impact functional exercises. He was virtually pain free and functional on Tuesday, 9/26 and was cleared for “go as can go” practice. As he jogged to the practice field, he felt a snap in his lower leg.

Signs and Symptoms Immediate disability and pain. Significant deformity four inches proximal to medial malleolus. Transported to emergency room with a vacuum splint

Differential Diagnosis Osteogenic sarcoma

Diagnostic Imaging/lab tests X-ray revealed an oblique fracture of the tibia approximately 2 inches distal to previous fracture site

Deviation from the Expected Some radiolucency (sp) was noted on x-ray on the previous x-ray (3/05) 4 months post fx at what became the new fracture site

Discussion Wolff’s law (weight encourages bone to heal) Fibula was bearing more than share not allowing the tibia to take full weight.

Discussion The oblique fx occurred due to a undectected stress fx (no pain in first month of season) The lower leg “contusion” in the game on Friday night may have caused a slight cortical “irritation.”

Treatment Open reduction, internal fixation with an intramedullary rod in the tibia Fibular osteotomy (Wolff’s law)

Conclusions Tibia stress fracture did not fully heal due to lack of stress on the bone. Tibia also has a poor blood supply in the middle 1/3 of the bone Implications: lack of weight bearing weakens bones (e.g. osteoporosis).

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