Abstract
Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profile, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. The mean age of the patient was 19.94 years. Total 74% of them developed first symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion). Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.
Highlights
Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges
An undisplaced femoral neck stress fracture with excellent prognosis if neglected, leads to displacement with increased complications
In recent annual audit of our orthopedic department, we noticed that five young soldiers who underwent total hip replacement were case of femoral neck stress fracture
Summary
Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. Stress fractures are usually reported in young military recruits and trainees.[1,2,3,4] But femoral neck stress fractures constitutes only in 5-10% of all stress fractures, but poses diagnostic and therapeutic challenges.[5,6] An undisplaced femoral neck stress fracture with excellent prognosis if neglected, leads to displacement with increased complications. Osteonecrosis of the femoral head or nonunion was the indication for surgery Based upon these facts, this retrospective study was conducted to analyze femoral neck stress fractures among military personnel for better patient care
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