CASE REPORT   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 September;177(9):496-500

DOI: 10.23736/S0393-3660.17.03584-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Bilateral tibial stress fracture successfully treated with ESWT in a runner

Matteo VITALI ¹, Nadim NAIM RODRIGUEZ ¹ ✉, Andreas DROSSINOS ², Gianfranco FRASCHINI ¹

¹ Department of Orthopedics and Traumatology, San Raffaele Scientific Institute for Research and Care, Milan, Italy; ² Vita-Salute San Raffaele University, Milan, Italy

Although stress fractures are common, sport-related bilateral stress fractures are rarely observed in the literature. Several high-risk factors lead to this event, which include excessive training in athletes that may lead to overuse injuries, as well as nutritional deficiencies and endocrine disorders. Few cases have been reported of bilateral tibial stress fractures in athletes. This article presents a case of a 59-year-old runner with a bilateral tibial stress fracture. The patient was treated with a cycle of three extracorporeal shockwave therapy (ESWT) sessions consisting of 4000 pulses of 0.55 mJ/mm2 with Storz Medical Dolith® SD1 machine once a week for three consecutive weeks. During the period of ESWT therapy, we performed a support treatment consisting of rest up to pain-free level, and NSAIDS in case of residual pain. Low-impact conditioning such as swimming and bicycling were allowed. A clinical evaluation and a MRI were performed at 1 and 3 months follow-up. At three months, the patient was pain-free and able to proceed with a gradual return to normal running activity. In this case report, a single cycle of ESWT produced an improvement of clinical and MRI aspects in bilateral tibial stress fractures. The neo-angiogenic effect of the ESWT seems to improve and accelerate the remission of symptoms.

KEY WORDS: Tibial fractures - Stress fractures - Running - Extracorporeal shockwave therapy