Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention

Abstract

Case: A 16-year-old African American multi-sport female athlete presents with bilateral worsening activity-related leg pain for 5 months. Multiple bilateral anterior tibial diaphyseal stress fractures and significant vitamin D deficiency were identified. She was treated with a combination of vitamin D supplements and static intramedullary nailing of the bilateral tibias resulting in clinical and radiographic healing and return to sports. Discussion: Vitamin D deficiency and high level of activity in a young athlete may be the etiology to atypical multiple stress fractures. In athletes who may want to return to sport rapidly, early operative intervention and correction of vitamin D deficiency may be treatment options. Level of Evidence: Level V- case report.

Keywords: adolescent athlete; anterior tibial diaphyseal stress fractures; bone health; high risk stress fractures; intramedullary nailing; vitamin D deficiency.

Figure 1

Lateral x-ray of left (A) and right (B) tibia and fibula.

Figure 2

One year post-operative lateral x-ray of the left (A) and right (B) tibia and fibula.