Lower Leg Injury in High School Football Player

1
Lower Leg Injury in High School Football Player

• Brooke Sallee, Andrew Noble, Danielle Doggett,
  Robert Confer, Edward Farrar, MD, Dale Blair, ATC
• Wenatchee High School
• Wenatchee,WA

2
History

• This 16 y/o football player had previously
  fractured tibia and fibula while snowboarding on
  December 27, 1998 (at age 14).

3
Snowboarding tib/fib fx 12/98
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, 2000.
• 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 (3/99) 4 months post fx at what
  became the new fracture site

10
Discussion

• Wolffs 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 (Wolffs 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