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

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

3. Snowboarding tib/fib fx 12/04

4. 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.

5. 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.

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

7. Differential Diagnosis
Osteogenic sarcoma

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

9. 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

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

11. 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.”

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

13. 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).

14. Thank you