Surgical repair and functional rehabilitation of a rare L5 triple stress fracture in an elite athlete: A case report

Background Lumbar stress fractures involving the pars interarticularis, inferior articular process, and lamina are rare. This report describes such a “triple stress fracture” in an elite athlete that was managed with a comprehensive strategy. Case presentation A 20-year-old professional volleyball player presented with fractures of the right pars and inferior articular process and the left lamina at L5. In the absence of stable anchorage points for standard fixation, we performed direct repair using the smiley face rod method. Rehabilitation focused on correcting restricted thoracic extension to eliminate compensatory stress. Bony union was achieved, and the patient returned to full competitive play 10 months after surgery. Conclusions The smiley face rod method can stabilize complex posterior element fractures when standard techniques cannot be used. Correction of the underlying biomechanical dysfunction may be important for reducing the risk of recurrence of these fractures in elite athletes.