Stress fractures of the tibia and fibula
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health Sciences University
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Associate Professor of Pediatrics
- Harvard Medical School
Stress fractures of the tibia and fibula occur in many athletes, especially runners, and also in nonathletes who suddenly increase their activity level or have an underlying illness predisposing them to stress fractures. Many factors appear to contribute to the development of these fractures including changes in athletic training, specific anatomic traits, decreased bone density, and disease states .
This topic review will discuss stress fractures of the tibia and fibula in adults. An overview of stress fractures and discussions of other specific fractures are found separately. (See "Overview of stress fractures" and "Stress fractures of the metatarsal shaft".)
The tibia is the major weight-bearing bone of the lower leg (picture 1 and picture 2). The proximal tibial plateau forms the lower surface of the knee joint (figure 1 and picture 3). The tibial shaft bridges the distance to the distal tibia, which contributes the superior articular surface of the ankle joint at the tibiotalar articulation as well as the medial malleolus. Another key bony landmark is the tibial tuberosity, which sits several centimeters below the joint line and serves as the attachment site for the patellar tendon. Although the tibial shaft is the most common site for stress fractures, they may also occur at the tibial plateau and the medial malleolus .
A strong fibrous structure, the interosseous membrane or ligament (figure 2), connects the tibia and fibula along the length of the two bones. Proximally, this structure, reinforced by strong anterior and posterior ligaments, forms a synovial joint, the proximal tibiofibular articulation (picture 4). Distally the interosseous membrane and three ligaments, the anterior, posterior, and transverse tibiofibular ligaments (figure 3 and figure 4), stabilize the superior ankle joint. Another fibrous structure, the crural fascia, surrounds the bones and muscles of the lower leg. Thus, although it bears far less weight than the tibia, the fibula is closely bound to the tibia by membranous and ligamentous attachments and is therefore susceptible to strain from some of the same deforming forces that cause tibial stress fractures .
Fascial extensions and the interosseous membrane separate the muscles, nerves, and vessels of the lower leg into four distinct compartments (figure 5). Three of these, the anterior, posterior, and deep posterior compartments, all border the tibia and can be compromised by tibial injury. The lateral compartment borders the fibula.
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- CLINICAL ANATOMY
- EPIDEMIOLOGY, RISK FACTORS, AND MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- DIAGNOSTIC IMAGING
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- Tibial stress fractures
- Fibular stress fractures
- Risk factor identification
- RETURN TO WORK AND SPORTS
- PEDIATRIC CONSIDERATIONS
- SUMMARY AND RECOMMENDATIONS