Abstract
Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.
Highlights
Stress fractures are infrequent lesions due to overloading and/or repetitive overuse and can occur at several sites, with the more common being the metatarsals, femoral/tibial shaft, and femoral neck. ey can be subcategorized into insufficiency fractures when an abnormal bone fractures under normal stresses and into fatigue fractures when a normal bone fractures under abnormal stresses [1]. e physiopathologic substrate is the combination of an imbalance between bone remodeling capacity and repetitive stress
Other treatment possibilities are intertrochanteric osteotomy or hip arthroplasty, either hemi or total (THA). e latter is mainly reserved as a salvage option in cases where previous surgical treatment has failed
If fracture lines are less than 50% of the neck, treatment of femoral neck stress fractures is nonoperative, consisting of non-weightbearing and activity cessation
Summary
Stress fractures are infrequent lesions due to overloading and/or repetitive overuse and can occur at several sites, with the more common being the metatarsals, femoral/tibial shaft, and femoral neck. ey can be subcategorized into insufficiency fractures when an abnormal bone fractures under normal stresses and into fatigue fractures when a normal bone fractures under abnormal stresses [1]. e physiopathologic substrate is the combination of an imbalance between bone remodeling capacity and repetitive stress. Femoral neck stress fractures (FNSFs) represent 5% of all stress fractures in the general population and are encountered more often, up to 15%, in athletes [1]. It is seen in long-distance runners and can be associated with the “female athlete triad” [2, 3]. We present the case of a young patient who presented with femoral neck stress fractures on both sides within a two-year span. THA has been chosen as a salvage procedure after nonunion following internal fixation on one side and as the primary surgical treatment on the other side
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