Treatment approach for stress fractures of the lower leg
Stress fractures usually appear in the lower leg due to repetitive loading and high-impact forces. Particularly vulnerable areas include the anterior tibial cortex, navicular bone, and proximal fifth metatarsal – all of which are susceptible to complications including delayed or non-union. The goal of the following systematic review is to compare surgical and conservative treatment for these high-risk stress fractures.
Conservative treatment for anterior tibial fracture resulted in high complication rates, with few subjects returning to sport. However, there was no comparison with surgical treatment due to a lack of studies deemed eligible for the authors’ criteria. Regarding navicular fractures, a mean 22-week return to sport compared with 16-weeks for conservative and surgical treatments respectively were identified – the former utilising six-weeks in a non-weight-bearing cast as the most common method. Lastly, weighted mean return-to-sport for the fifth metatarsal fracture was 19 and 14 weeks for conservative and surgical treatments repectively.
Overall, there was a high risk of bias; sample sizes were small and grade level of evidence was low.