Medial Tibial Stress Syndrome After Intramedullary Nailing for a Distal Tibial Fracture: A Case Study

Background: The gold standard for tibial shaft fractures includes tibial fixation with intramedullary nailing. There are several complications following this surgical procedure, but Medial Tibial Stress Syndrome (MTSS) was not included in research. Patient: A 19-year-old female Division I soccer player had an open treatment of a right tibial shaft fracture with intramedullary nailing after a distal transverse fracture while playing soccer. Due to pain with kicking, the distal nails located on the distal tibial shaft were removed. Post surgically, the patient reported a significant increase in shin pain while returning to activity, which was later attributed to medial tibial stress syndrome (MTSS). This case is unique because MTSS has not been reported as an adverse effect after intramedullary nailing. Intervention: After the second surgical procedure, conservative treatment was done that focused on lower extremity strength, proprioception, and modalities to control pain and facilitate healing. Discussion: After 5 months of conservative rehabilitation of MTSS, the injury was closed. The patient is able to function without pain unless there is a surface change for activity. Purpose: This case study highlights the importance of understanding the adverse effects and risks of surgical procedures, as well as uncommon side effects. Enhanced understanding of this surgical procedure and injury can improve the outcomes of this type of procedure.