Bilateral Femoral Neck Stress Fractures Research Articles

Bilateral Stress Fracture of the Femoral Neck: A Case Report

Bilateral femoral neck stress fracture is rarely seen. Two radiologic types of femoral neck stress fracture, the transverse and the compression, have been described. This differentiation bears importance in the choice of treatment. In this report, we presented a case of bilateral femoral neck stress fracture with a short review of contemporary literature.

Bilateral symmetrical stress fractures of femoral neck in HIV patient: case report and brief review of literature

Osseous changes in HIV positive patients receiving ART are three times greater than in normal individuals. These changes include osteopaenia/osteoporosis, stress fractures, fragility fractures and osteonecrosis. On an average, bone mineral density reduces by 2-6% in the first 2 years after commencement of antiretroviral therapy. High risk for stress fractures is observed in these patients. In present article, we report a case of bilateral femoral neck stress fractures in a known HIV patient.

Bilateral stress fracture of the femoral neck in association with simultaneously developing osteonecrosis of the femoral head: a case report

BackgroundFemoral neck stress fractures are rare and often recognized as overuse injuries that occur in young athletes or military personnel. A case following osteonecrosis of the femoral head is quite rare; even more uncommon is its occurrence in the bilateral hips. Magnetic resonance imaging has been established as the preferred tool for diagnosing nondisplaced femoral neck stress fracture due to overuse injury. Magnetic resonance imaging was also useful to detect the initial lesion even in this case, although the etiology was different between overuse injury and insufficiency fracture.Case presentationA 41-year-old Japanese woman diagnosed with bilateral early stage idiopathic osteonecrosis of the femoral head was observed non-weight-bearing as much as possible using a stick. However, her pain and difficulty in walking progressed. Bilateral femoral neck stress fractures were subsequently detected by magnetic resonance imaging. The fracture initially appeared as a spot of bone marrow edema at the medial site of the femoral neck, and then developed into a fracture line. The patient underwent internal fixation of both hips with sliding hip screws to stabilize the stress fractures. In addition, the preparatory reaming served as core decompression of the femoral heads, as well as being treatment for osteonecrosis. Her bone mineral density and 25-hydroxy vitamin D values were low for her age. We administered eldecalcitol and teriparatide acetate. Her symptoms mostly improved, and the fracture lines and necrotic lesions on magnetic resonance imaging reduced at 5 months after the surgery.ConclusionsBilateral femoral neck stress fractures are a very rare condition and are often missed. It is important to listen to the patient’s complaints and perform an appropriate examination. We encountered a case of bilateral femoral neck stress fracture that occurred in a patient with early stage osteonecrosis of the femoral head, and were able to observe progression of stress fracture since before fracture occurred. This is considered to be the first report to capture imaging changes before and after the onset.

SAT-362 A Bone to Pick with FGF23

A 48 yo M with a past medical history of bilateral femoral neck stress fractures at age 44 status post closed reduction percutaneous pinning (CRPP) presented to the emergency room with bilateral lower extremity pain after a ground level fall. Plain films were notable for a right intertrochanteric fracture and left hip nonunion. The patient underwent removal of right CRPP hardware and revision fixation with a short TFN-Advanced Femoral Nailing System (TFNA) and fixation of the left femoral neck nonunion. Given his injuries following a ground level fall, endocrinology was consulted for recommendations. Labs during his hospital course were notable for hypophosphatemia as well as normal levels of alkaline phosphatase, serum calcium, and PTH. Serum protein electrophoresis and urine protein electrophoresis were within normal limits. A 24-hour urine calcium and phosphorous were done and the patient was found to have a low calculated renal phosphate threshold (TmP04/GFR), concerning for hypophosphatemic osteomalacia. An FGF23 level was drawn and was elevated, suggestive of an FGF23-induced hypophosphatemic osteomalacia. A low vitamin D 1,25-OH was also found consistent with this process, given interference of alpha-hydroxylation of vitamin D 25-OH from FGF23. The patient therefore underwent a PET scan to rule out a mesenchymal tumor-induced osteomalacia but his PET scan was largely unremarkable. Given that there were no issues with bone development or fractures during childhood, the suspicion for X-linked hypophosphatemia or autosomal recessive hypophosphatemia was low. The patient was believed to have either a small mesenchymal tumor not seen on PET scan or an autosomal dominant hypophosphatemia, which can manifest clinically during adulthood, and so was treated with daily Calcitriol and phosphate with subsequent correction of his serum phosphorous. Such a delayed presentation of hereditary hypophosphatemic osteomalacia, however, has been reported only in women either soon after puberty, during pregnancy, or after delivery (1). This case thus represents a possible autosomal dominant hypophosphatemia in a male patient or a rare case of tumor-induced hypophosphatemic osteomalacia.Reference: (1) Drezner MK, Whyte MP. Heritable renal phosphate wasting disorders. Genetics of bone biology and skeletal disease, 2nd ed. 2018; 761–782.

Failed Internal Fixation in Bilateral Femoral Neck Stress Fracture Salvaged with Total Hip Arthroplasty: A Report of Two Cases with Literature Review.

Bilateral Femoral neck stress fractures (FNSFs) are rare without any underlying metabolic disease or repeated strenuous activities like athletes or military recruits. It constitutes about 5-8% of all stress fractures. Treatment options are still controversial. We report two young women with bilateral simultaneous FNSFs without any metabolic cause, presented to us following failed internal fixation with cancellous screws and neck resorption salvaged with total hip arthroplasty. Compression type stress fracture healed in the final follow-up on the other side.

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature.

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.

Bilateral Femoral Neck Stress Fracture Presented with Unilateral Symptoms in a Shipman Laborer: A Case Report

Femoral neck stress fracture occured commonly in athlete and military recruit populations, some of them are bilateral. Bilateral femoral neck stress fracture that associated with other occupation is very uncommon. We report a bilateral femoral neck stress fracture case that presented with unilateral symptoms in a male shipman laborer. The patient was successfully treated conservatively. Stress fracture sometimes occur associated with an unexpected specific occupation. Consideration of bilateral involvement is highly important in managing stress fracture.

Bilateral Simultaneous Femoral Neck Stress Fracture Despite Clinical Recovery from Anorexia Nervosa

A 38-year-old woman who had returned to sports activity (running) after having clinically recovered from anorexia nervosa presented with a bilateral femoral neck stress fracture that was treated with bilateral hip osteosynthesis. Although exercise is usually considered to be beneficial for health, heavy exercise (such as running) after recovery from anorexia nervosa may be associated with an increased risk of fracture.

Simultaneous bilateral femoral neck stress fractures in a young female runner: A case report and review of literature

Fatigue fractures generally appear in normal bone following increased repetitive activity or strenuous exercise, when imbalance occurs between applied force and elastic resistance. Femoral neck fatigue fractures are most common in athletes and young military recruits. They are not as common as stress fractures of the metatarsals or tibia and other bones. This paper reports bilateral stress fractures of the femoral neck in a 14-year-old girl presenting with pain in the anterior aspect of the right thigh of 3 months duration and without evidence of previous injury with low Vitamin D and elevated parathyroid hormone levels. Correction of Vitamin D levels, bed rest, and relief of weight-bearing were indicated as fractures were undisplaced.

Rapid Magnetic Resonance Imaging Evaluation of Femoral Neck Stress Fractures in a U.S. Active Duty Military Population.

Timely diagnosis of femoral neck stress fractures is important to prevent fracture completion and displacement. We hypothesize that an abbreviated magnetic resonance imaging (MRI) hip examination can diagnose femoral neck stress fractures and that femoral neck stress fractures are common in U.S. military recruits. We retrospectively reviewed abbreviated hip MRI examinations performed on active duty patients from November 1, 2013, to August 5, 2014. Patients were referred by primary care providers on the basis of high clinical suspicion. Study variables included presence and grade of femoral neck stress fractures. 229 patients were evaluated with an abbreviated hip MRI. 43 patients (18.8%) were diagnosed with femoral neck stress fractures and 12 patients (5.2%) had bilateral femoral neck stress fractures. All femoral neck stress fractures were on the compressive side. Grading of stress fractures was as follows: 0 Grade I (0%), 8 Grade II (14.5%), 32 Grade III (58.2%), and 15 Grade IV (27.2%). An abbreviated MR hip examination can diagnose femoral neck stress fractures as well as additional pathologies that explain the patient's symptoms. Femoral neck stress fractures are common in U.S. military personnel.

Bilateral femoral neck stress fracture following bilateral total knee arthroplasty: a case report

In the treatment of degenerative knee arthritis, total knee arthroplasty is a commonly performed surgery. After knee replacement, stress fractures at lower extremity may rarely occur due to changes in lower extremity alignment and biomechanical axis. We report an 82-year-old woman with a bilateral femoral neck stress fracture 3 years after bilateral total knee replacement. Physicians should be aware of this rare complication and these fractures should be treated without any surgical delay.

Simultaneous bilateral femoral neck stress fractures in a young military cadet: a rare case report.

Simultaneous bilateral femoral neck stress fracture in healthy young adult is one of the very rare clinical entities that an orthopedic surgeon may encounter once in lifetime. Bilateral femoral neck stress fractures have been very well documented in elderly and osteomalacia patients; however, its simultaneous occurrence in a healthy adult is challenging to diagnose and manage. This article describes a 34-year-old man a military personnel who sustained bilateral stress femoral neck fractures, during a routine training activity. The patient was come to our institution, and a full endocrine evaluation was performed and proved unremarkable. He underwent closed reduction and internal fixation of the fractures using cannulated screws on both the sides. At 1-year follow-up, the fractures went on to complete union. Despite strict non-weight-bearing instructions for initial 3-month period, patient bore weight on the limbs resulting in varus union on the left side. Our case emphasizes the significance of obtaining a complete and thorough medical history on physical examination and appropriately counseling patients regarding activity level even after successful fixation.

Bilateral Femoral Neck Stress Fractures in a Fire Academy Student

Unilateral femoral neck stress fractures are well documented in active patients; however, the risk of a subsequent contralateral stress fracture remains unknown in patients who continue to be active. This article describes a 24-year-old male fire academy student who sustained a left femoral neck stress fracture, followed approximately 11 months later by a right femoral neck stress fracture, both of which went on to completely displace. A review of the index radiographs of each hip from outside institutions revealed femoral neck stress fractures that went undiagnosed until they displaced. The patient was referred to our institution and underwent closed reduction and internal fixation using cannulated screws in both cases. A full endocrine evaluation was performed in the following weeks and proved unremarkable. Although it is difficult to extrapolate the results from 1 patient beyond the case studied, there is cause for concern in patients who remain active following femoral neck stress fractures. Our case highlights the significance of obtaining a complete and thorough medical history on physical examination and appropriately counseling patients regarding activity level. Until further research explores this possible relationship, physicians evaluating patients with a history of a stress fracture are encouraged to be vigilant of subsequent contralateral fractures and educate patients of this potentially avoidable injury.

Concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the hip: a case report

Concurrent bilateral femoral neck stress fractures and unilateral osteonecrosis of the hip: a case report

19-Year-Old Male Adolescent with Bilateral Femoral Neck Stress Fractures: A Case Report

The medical literature describes very few cases of bilateral femoral neck stress fractures in healthy adolescents. We studied the case of a healthy adolescent male Marine who suffered severe bilateral femoral neck stress fractures within a span of 7 months. As his level of exercise was no different than his other colleagues, his case was closely scrutinized using biochemical studies, bone specimens, and activity modification over the course of several months. Laboratory studies and observation yielded unremarkable findings, and he went on to return to full training regimens for combat deployments. Thus, even in young healthy males, this type of injury can occur without bony pathology; furthermore, an aggressive surgical approach can result in an optimal outcome.

Bilateral femoral neck stress fractures following total knee arthroplasty: a case report and review of literature

Stress fracture of the femoral neck following total knee arthroplasty (TKA) is an uncommon complication with only 20 cases having been described in English literature so far. Stress fractures of femoral neck occurring simultaneously on both sides following a bilateral total knee replacement is an exceptional occurrence, which to the best of our knowledge, has not been described previously. We describe a patient suffering from osteoarthritis of both knees, who was treated with bilateral total knee arthroplasty simultaneously. He developed spontaneous fractures of femoral neck on both sides 9 months following the total knee replacement in the absence of any known risk factors for stress fractures. He was treated with bipolar hemi replacement arthroplasty for displaced fracture on one side and closed reduction/internal fixation on the undisplaced side. A high index of suspicion is needed to diagnose this unusual complication of total knee arthroplasty before the fracture displaces necessitating a prosthetic replacement.

Concurrent Bilateral Femoral Neck Stress Fractures and Osteonecrosis of the Hip: A Case Report

Although bilateral osteonecrosis of the femoral head and bilateral stress fracture of the femoral neck are well-documented conditions, the occurrence of both conditions in the same patient has not been reported, to our knowledge. We present the case of a patient with both entities who was managed with internal fixation of both hips, which provided stabilization of the stress fractures as well as treatment of the osteonecrosis with core decompression. Two years after treatment, the stress fractures had healed and there was no evidence of progression of the osteonecrosis. The patient granted permission for the publication of data concerning the case. Aforty-six-year-old woman presented to us with a six-month history of bilateral groin pain. The right hip was more painful than the left. There was no history of trauma. The medical history included interstitial nephritis, diagnosed on the basis of a renal biopsy performed five years earlier, and osteopenia, diagnosed on the basis of a bone mineral densitometry value that was -1.25 standard deviations below the mean for age and sex-matched controls. The nephritis was treated with a three-month course of prednisone at the time of the initial diagnosis. The serum creatinine level remained elevated at 2.0 to 3.2 mg/dL (176.8 to 282.9 μmol/L), but that level had remained stable since the diagnosis of interstitial nephritis five years earlier. The patient had not received medical treatment for the osteopenia although it was recommended to her at the time that the densitometry was performed. The patient had a history of drug and alcohol abuse more than twenty years previously, but she stated that she had not used drugs or alcohol since that time. There was no history of amenorrhea or an eating disorder. The patient stated that she was an “avid” runner, running >5 mi (>8 km) every morning, prior to …

Bilateral Femoral Neck Stress Fractures in an Adolescent Male Runner

Bilateral Femoral Neck Stress Fractures in an Adolescent Male Runner

An unusual extraspinal cause of bilateral leg pain

Low back pain with pain radiating to the lower extremities is common in patients referred to a spine center. Lumbar spine pathology is commonly the etiology of such symptoms, but extraspinal causes of back and leg pain can manifest as a radicular disorder. Extraspinal etiologies must be considered in the workup of back and leg pain. This report describes an unusual case of spontaneously occurring bilateral femoral neck stress fractures presenting as low back pain with seemingly bilateral L4 radicular symptoms.

Bilateral femoral neck stress fractures following steroid treatment

Bilateral femoral neck stress fractures following steroid treatment