The footballer's fracture.

OBJECTIVE To describe the typical tibial diaphyseal fracture ("footballer's fracture") and to clarify the circumstances and mechanism of the injury. METHODS In an attempt to obtain a detailed analysis of the types of injury suffered, and thereby highlight areas for prevention, 100 consecutive adult football players with a tibial diaphyseal fracture were studied prospectively. Details of the circumstances and mechanism of injury were collected using a questionnaire (response rate 85%). Treatments depended on the Gustilo classification, displacement, and axial stability. Long term follow up was performed until clinical healing to define the overall prognosis. RESULTS 61% of players suffered a fracture of both the tibia and the fibula. Ninety five percent of the tibial fractures were transverse or short oblique and were caused by impact during a tackle. Radiographic evidence of bridging callus was better than a classification of the bony injury for predicting weeks to clinical healing. The delayed union and non-union incidence following this injury is low. One patient suffered symptomatic shortening. One patient suffered symptomatic angulation and two patients with nonunion required bone grafting. CONCLUSIONS Tibial fracture is an expensive injury. It prevents a young population from being employed and takes up valuable NHS resources. As 85% of players were wearing shin guards, it is likely that improvements in shin guard design could reduce the rate of tibial fracture.