A young marathon runner is paicipating in a marathon competition. After running for 100 m, he develops at the anteromedial aspect of tibia which was mild to sta with, but increased on fuher running. X ray was normal. The doctor ordered a bonescan. What is the likely diagnosis?
(A) Lisfranc fracture (B) Jones fracture (C) Shin splint (D) Nutcracker fracture
(C) Shin splints (stress fracture) are seen in runners, army recruits or any vigorous physical activity. STRESS/FATIGUE FRACTUREStress fracture is due to imbalance between load and resistance of bone. It is of 2 types:1. Fatigue Fracture: caused by application of abnormal stress on normal bone.2. Insufficiency Fracture: caused by normal activity on weak bone. Sites of Stress FracturesLower Extremity* March fracture is a stress fatigue fracture of second metatarsal neck > 3rd metatarsal neck.* The most common site is metatarsal neck followed by tibia (proximal third in children, middle third in athlete and lower third in elderly).* Tibia stress fracture = Shin splints* Femoral neck (inferomedial compression side in young and superior tension side in older patients).* Rarely fibula lower end (runners fracture). Upper Extremity* Olecranon is most common site of upper limb stress fractures. Pelvis and SpinePars inter aicularis of 5th lumbar veebral (causing spondylolysis) is commonest in spine. Clinical Presentation* Load related pain often bilateral* The hallmark physical finding is tenderness with palpation and stress. InvestigationMRI provide excellent sensitivity and superior specificity compared to bone scan in differentiating from infections or tumors.Bone scan is preferable for bilateral cases due to feasibility, also bilateral cases go in our of stress fracture as compared to Infection or tumor and also can scan the whole body.* Treatment is symptomatic with cast and cessation of activity.