Stress fractures in the young adult hip

Abstract

A stress fracture is caused by repeated suboptimal loading on a bone over time as opposed to a single severe impact. They occur when the stress on a bone exceeds the capacity of the bone to withstand and heal from the recurrent stresses. These can occur in highly committed athletes, and in patients participating in sports or activities involving repetitive, weight-bearing activity. Stress fractures have a predilection for certain bony locations, with most occurring in the lower extremities. They occur in less than 1% of the general athletic population, but the incidence in running/track athletes can be 10–20%. Femoral neck stress fractures account for 11% of all stress fractures. There are two types: insufficiency fractures due to secondary osteoporosis, and fatigue fractures resulting from repetitive loading as may occur in athletes, runners and military recruits. In this paper we explore the literature and review causative factors for femoral neck stress fractures. We review optimum diagnostic imaging and review treatment options for the management of what can seem to be an indolent pathology but if delay in diagnosis occurs, can have catastrophic outcome for the affected hip.