Hip Fracture In A Healthy Collegiate Distance Runner Without Relevant Hip Symptoms

Abstract

HX: A 20-year-old female Division I collegiate distance runner sustained a traumatic right femoral neck fx due to slipping while competing in the conference cross-country championships in February of 2021. She presented to AT and PT in the Spring of 2020 with bilateral, lateral knee pain consistent with ITBS. She had a history of metatarsal stress fx the previous season. The athlete had a normal DEXA scan, normal blood work, and self-reported no history of amenorrhea. PE: Pre-fracture, the athlete had full hip and knee AROM and PROM without pain. The athlete was able to run 40-50 miles per week without exacerbation of ITBS, including 10-12 mile long runs without symptoms. Athlete underwent uncomplicated ORIF following injury to stabilize the fracture. Bony healing was delayed until 7 months post-op. An athlete was making progress with rehab as expected through the end of the school year (3 months post-op) before returning home for summer. Upon returning to campus from summer vacation, the athlete had a plateau in her rehab process. She began to exhibit leg length discrepancy, pelvic position abnormalities, grossly limited AROM/PROM of hip extension and ER, significantly decreased strength of the R LE, and limited capsular mobility of the hip. DDX:Pre-injury-ITBS/TFL Strain-Vastus Lateralis Muscle Strain-FAIPost Injury-FAI-Scar tissue formation in posterior hip-CRPS-Lumbopelvic Dysfunction TESTS & RESULTS:-Multiple plain radiographs showing delayed healing until 7 months post-op-MSK US showing scar tissue formation at the greater trochanter near gluteus medius insertion and near the superior gluteal nerve-Bloodwork pending WORKING DIAGNOSIS: -Pathological Femoral Neck Fx w/delayed healing s/p ORIF w/ associated FAI secondary to lumbopelvic dysfunction TREATMENT AND OUTCOMES:The athlete performing dual and single limb lower extremity strengthening exercises including closed-kinetic chain w/resistance. She went through a return to walking/jogging protocol and was able to jog on the track for 400 m before the plateau in progress. She is currently performing dual-leg bodyweight bridges and basic leg lifts. The athlete is unable to perform single-leg bridges on right. AT and PT performing graded joint mobilizations to promote extension and external rotation.