Femoral Neck Stress Fracture Research Articles

A Displaced Femoral Neck Stress Fracture in an Amenorrheic Adolescent Female Runner

This case demonstrates the potential serious consequences of the female athlete triad and its effects on bone. Displaced femoral neck stress fractures cause significant morbidity, and this case highlights the preventable nature of this injury. The treatment was focused on improving low energy availability, and, although challenging, improvements were made. This injury could have been prevented if the signs and symptoms of her injury had been addressed and there had been better knowledge of her risk factors. This case highlights the need for further education in the sports and health communities.

Femoral Neck Stress Fracture and Femoroacetabular Impingement

The patient was a 34-year-old male recreational marathon runner referred to a physical therapist with a chief complaint of worsening right lateral hip pain of 3 months duration that was insidious in nature. Following a physical examination, the physical therapist discussed his suspicions with the referring physician. Magnetic resonance imaging revealed findings consistent with a stress fracture at the inferomedial right femoral neck, a mild cam-type deformity of the right femoral neck, and a mild degree of heterogeneity of the right superior anterior labrum, representing a possible tear.

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.

Insufficiency stress fractures of the femoral neck in children

Stress fractures can be subdivided into fatigue fractures caused when normal bone is exposed to abnormal stress and insufficiency fractures where normal stress is applied to abnormal bone. Stress fractures of the femoral neck, although uncommon, have a high complication rate if the diagnosis is missed or the patient is improperly treated. Femoral neck stress fracture in children is a rare event. Eight children with 10 insufficiency fractures of femoral neck were treated successfully. There were 2 boys and 6 girls with the average age 11 years. The right hip affected in 4 children and the left hip in 2 and 2 children with bilateral hip affection. Four fractures were incomplete, and 6 were complete. The average follow-up period was 5 years. The time for radiological union ranged between 6 and 12 weeks (average 8 weeks). The time for full weight bearing ranged between 4 and 8 weeks (average 6 weeks). Most of the children became asymptomatic from the fracture at the average of 7 weeks. Stress insufficiency fracture of the femoral neck in children considered as high-risk fracture and should be treated aggressively with attention to lower the risk of additional fractures and preserve quality of life in these children. So, intervention should be targeted toward limiting further bone loss and decrease the risk of falls.

Femoral Neck Stress Fracture in a Military Trainee

The patient was a 21-year-old female who was currently enrolled in a military security forces training program. She had a 1-month history of worsening left anterior hip pain that was insidious in nature and limiting her ability to run. The patient was diagnosed as having a left hip strain, prescribed a nonsteroidal anti-inflammatory medication,given a reduced activity waiver, and referred to a physical therapist. Despite previous radiographs of the pelvis and hips that were interpreted as normal, the history and physical examination findings led the physical therapist to be concerned about the presence of a possible femoral neck stress fracture. Immediate magnetic resonance imaging of the left hip was obtained, which revealed a stress fracture of the basicervical portion of the left femoral neck. The patient was referred to an orthopaedic surgeon for an expedited consultation and underwent open reduction internal fixation of the left hip later that day. After a period of convalescence and completion of a comprehensive rehabilitation program, the patient successfully returned to full military duty without limitations.

Genetic predisposition for femoral neck stress fractures in military conscripts

BackgroundStress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures.ResultsEight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI.ConclusionsOur findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

Atypical femoral neck stress fracture in a marathon runner: a case report and literature review

Femoral neck stress fractures are relatively rare and may present as sports-related injuries. The presentation is variable, and prompt diagnosis facilitates the earliest return to pre-morbid functional activity levels. Delayed detection may precipitate femoral non-union or avascular necrosis, resulting in long-term functional deficit. We present the case of a basicervical femoral neck stress fracture occurring in a 23-year-old marathon runner. The pathophysiology and practical management issues related to this unusual injury pattern are discussed. The growing interest in amateur athletic activities should raise the index of suspicion for stress fractures of the femoral neck in healthy adults with atypical hip pain. Increased levels of patient education and physician awareness can reduce the incidence of long-term morbidity in cases of this unusual sports-related injury.

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.

Hip And Buttock Pain - Runner

HISTORY: A 50-year-old female presents 10 days pre-marathon with gradually increasing right hip, back and buttock pain for 5-6 weeks, worsening to where she is hardly able to run. She has increased her weekly mileage to 30 miles, with her longest run 22 miles. She has pain in her right anterior and posterior thigh. Her hip pain radiates to her groin and antero-medial thigh. Her posterior thigh pain radiates from the buttock to the knee. She reports her pain is 20% back and 80% leg. She denies weakness, neurologic or systemic symptoms. PHYSICAL EXAMINATION: Gait is antalgic. Hop test positive for hip pain. Hip ROM is slightly restricted on right side. Quadrant test and log rolling of the hip mildly painful. No palpable tenderness. Straight leg raise reproduces her index posterior thigh pain. Power, sensation and reflexes were normal. DIFFERENTIAL DIAGNOSIS: Lumbar radiculopathy Sciatica Femoral stress fracture Hip osteoarthritis TEST AND RESULTS: Radiographs: Standing AP pelvis, supine frog leg: No evidence of femoral stress fracture or periosteal reaction. Slightly increased femoral neck offset consistent with FAI, and early degenerative changes. Standing AP, lateral of LS spine No acute bony abnormality. MRI pelvis and right hip were ordered, and performed 5 days later: No evidence of femoral neck or shaft stress fracture. Reactive edema of the proximal hamstring origin on the ischial tuberosity, consistent with grade 1 strain and partial avulsion. MRI lumbo-sacral-spine: Right-sided lateral L3-4 disc impinging on exiting L3 nerve root. FINAL / WORKING DIAGNOSIS: Hip pain secondary to L3 radiculopathy Posterior thigh pain secondary to hamstring insertional tendonitis TREATMENT AND OUTCOMES: Day-0: Advised to stop all impact activities until MRI results available. She was advised to do non-impact activities and pool running Day-5: Following the MRIs, fluoroscopy-guided selective right L3 nerve root block, provided significant relief of hip and anterior thigh pain. Day-6: ESWT to the hamstring origin on the ischial tuberosity provided immediate pain relief in her posterior thigh. Day-10: able to walk/run marathon without much difficulty. Day-13: Second ESWT provided additional pain relief in her posterior thigh. Day-14: Hop test negative. Normal nerve tension. Hip and anterior thigh pain improved.

Failed ITB Syndrome Rehab in a Female Runner with Hip Pain

HISTORY: A 37 year old female with past medical history significant for uterine fibroids presented with persistent left hip pain. She described her left hip pain as an achy, heavy sensation brought on only with running or prolonged sitting. She was initially seen by her PCP and initial hip xray report was read as negative. The patient discontinued running for 10 months and during that time, was pain free. However resumed running, her hip pain returned. The patient then went to a sports medicine physician who referred her for physical therapy. The patient also had repeat hip/pelvis xrays which showed large calcified fibroid. The patient underwent months of physical therapy focusing on iliotibial band stretching but had little improvement in her left hip pain. The referral was then made to a musculoskeletal physiatrist specializing in pelvic floor dysfunction. PHYSICAL EXAMINATION: Examination revealed normal gait, lumbar spine and hip ROM. Gillet test, Faber's test and Scour tests were negative. Slump sit was negative. Ober's test was positive. Ely's test was positive. Left greater trochanter was non-tender to palpation. Mild pain with palaption of left psoas and iliacus muscles on left. Pelvic exam: Palpation of the left pelvic floor was tender with taut bands found in the left levator ani. Palpation of the left obturator internus muscle reproduced the patient's left hip pain. The patient had difficulty relaxing her left pelvic floor. DIFFERENTIAL DIAGNOSIS: Iliotibial band bursitis Femoral neck stress fracture Pelvic stress fracture Hyperonic pelvic foor dysfunction Gluteus medius strain TEST AND RESULTS: The patients most recent hip/pelvis xrays were reviewed which showed large calcified fibroid. No other abnormalities were seen in the hips or pelvis. FINAL WORKING DIAGNOSIS: Pelvic floor dysfunction secondary to fibroids causing referred pain to left hip TREATMENT AND OUTCOMES: Pelvic floor physical therapy for hypertonic pelvic floor with attention to releasing taut bands in her left levator ani muscle. The patient completed 4 wks of physical therapy and was instructed to slowly build up her previous running distance and speed. On follow up visit the patient reported diminished left hip pain with running as well as with prolonged sitting. Plan for future myomectomy prn

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

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Acetabular retroversion (AR) alters load distribution across the hip and is more prevalent in pathologic conditions involving the hip. We hypothesized the abnormal orientation and mechanical changes may predispose certain individuals to stress injuries of the femoral neck. We retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 54 patients (108 hips) treated for a femoral neck stress fracture (FNSF) and compared these radiographs with those for a control group of patients with normal pelvic radiographs. We determined presence of a crossover sign (COS), femoral neck abnormalities, and neck shaft angle. The prevalence of a positive COS was greater in patients with stress fractures than in the control subjects (31 of 54 [57%] versus 17 of 54 [31%], respectively) and higher than for control subjects reported in the literature. Thirteen patients had radiographic changes of the femoral neck consistent with femoroacetabular impingement (FAI). These radiographic abnormalities were seen more commonly in retroverted hips. A greater incidence of AR was noted in patients with FNSF. Potential implications include more aggressive screening of military recruits with AR and the new onset of hip pain. Finally, we present an algorithm we use to diagnose and treat these relatively rare FNSFs. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Persistent Hip Pain In A Football Player

HISTORY: 22 y/o male FB player with 3 week history of intermittent R hip flexor pain, worse with hip internal rotation and flexion. No acute trauma. He underwent an intra-articular injection with lidocaine, bupivacaine and depomedrol with aspiration of clear, synovial fluid. Immediately post injection, he had resolved hip joint pain, but c/o deep persistent 1/10 pain over hip flexors. Over 7 days hip flexor pain worsened from 4 to 9/10, with stiffness, worse with hip extension. No F/C, N/T, weakness, back, testicular or urinary pain, B/B incontinence, or GI sx. PHYSICAL EXAMINATION: Heart, lungs and abd exam WNL. (+) Trendelenburg gait. TTP along and inferior to R inguinal ligament. Hip was painful with int. rotation, & passive, active and resisted hip flexion. No pelvic or leg length asymmetry. No pain over the pubis or with valsalva. No palpable hernia. DIFFERENTIAL DIAGNOSIS: 1) Hip Flexor Strain 2) Femoral acetabular impingement 3) Labral Tear SECONDARY: 4) Psoas Abscess 5) Septic Arthritis 6) Femoral Neck Stress Fracture 7) Iliopsoas Bursitis TEST AND RESULTS: 1) AP pelvis and R hip false profile view: a. Mild FAI with decreased anterior femoral head/neck offset. b. Small fibro-cystic lesion, ant-lateral neck of the femur. 2) IA Hip Injection a. Aspiration of 3 ml of clear synovial fluid with 7 to 0/10 pain reduction in hip pain. b. Neg Gram stain & cx. 3) WBC 17.1, 83.6% PMN's, CRP 15.1, ESR 25 4) Hip MRI w/o contrast: a. Complex heterogeneous fluid in psoas muscle to the illiacus (abscess vs hematoma). b. Decreased femoral head/neck offset, no labral tear 5) U/S guided aspiration of fluid collection in the illiacus done before antibiotics. a) 50ml of opaque, light brown, purulent material. Culture negative. 6) I&D of psoas/ illiacus fluid collection with placement of penrose drain. a. Gram stain neg but culture positive for methicillin sensitive staph aureus (MSSA). 7) Blood culture neg x 2 FINAL WORKING DIAGNOSIS: 1) Iliacus and Psoas Abscess 2) Femoral Acetabular Impingement TREATMENT AND OUTCOMES: 1) Piperacillin/Tazobactam and Vancomycin IV started, then Nafcillin IV for 2 weeks via PICC line after cx's positive for MSSA. On completion of IV therapy, he was treated with Dicloxacillin PO for 10 days. 2) Held from play for 6 weeks until full, pain free ROM, no pain with hip flexion, weight bearing, or sport-specific motions.

Femoral Neck Stress Fracture Complicated by Deep Venous Thrombosis and Complex Regional Pain Syndrome: A Case Report

Femoral Neck Stress Fracture Complicated by Deep Venous Thrombosis and Complex Regional Pain Syndrome: A Case Report

Femoral Neck Stress Fractures in Military Personnel

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.

Poster 118: Compression Side Femoral Neck Stress Fracture Complicated by Deep Vein Thrombosis and Complex Regional Pain Syndrome: A Case Report

Setting: Outpatient sports medicine clinic. Patient: 37-year-old woman triathlete with osteopenia and amenorrhea with a left medial side femoral neck stress fracture. Case Description: This patient developed left hip pain while doing sprints; she had completed a triathlon 4 weeks prior. Magnetic resonance imaging (MRI) showed a left compression side stress fracture. She was prescribed non-weight bearing status on the left lower limb. 3 days following the institution of the nonweight bearing status, she developed left-sided lower-limb swelling.

Comparison of Planar Scintigraphy Alone and with SPECT for the Initial Evaluation of Femoral Neck Stress Fracture

The objective of our study was to compare the accuracy of planar scintigraphy alone versus planar scintigraphy with SPECT for the initial evaluation of femoral neck stress fractures in a young military population. We retrospectively identified 38 patients who had undergone planar scintigraphy and 33 patients who had undergone planar scintigraphy and SPECT before MRI of the hips over a 6-month period for evaluation of suspected femoral neck fracture. Data were analyzed regarding the sensitivity and specificity of bone scanning alone and with SPECT for detecting femoral neck stress fracture and grading fractures as low grade (grades I and II) or high grade (grades III and IV). Twelve fractures were identified in the group who underwent planar scintigraphy alone and 13 in the group who underwent planar scintigraphy with SPECT. The sensitivities of planar scintigraphy alone and with SPECT were 50% and 92.3%, respectively (p = 0.03). The accuracy of each technique for the detection of high-grade fractures was 12.5% and 70%, respectively (p = 0.025). Planar scintigraphy with SPECT had a higher sensitivity and accuracy in assessing the grade of femoral neck stress fractures than planar scintigraphy alone. The results of this study suggest that SPECT should be performed with planar bone scintigraphy for the evaluation of patients with suspected femoral neck stress fractures.

Femoral Neck Stress Fracture in a Male Runner

A 37-year-old male, referred to physical therapy by his physician, presented with a recent onset of left anterior hip and groin pain. Radiographs of the pelvis, left hip, and left femur were negative. After 2 weeks of rest and physical therapy, the patient was referred back to his physician for further investigation due to lack of improvement in symptoms. Magnetic resonance imaging revealed findings consistent with a stress fracture on the inferior (compression) side of the femoral neck. Stress fractures of the femoral neck can be difficult to diagnose, since standard radiographs are typically not diagnostic in the early stages. It is not until the healing phase, approximately 3 weeks after onset, that the stress fractures may become apparent on standard radiographs. Given the potential for dire outcomes, especially with superior (tension) side stress fractures, early diagnosis is paramount. J Orthop Sports Phys Ther. 2008;38(8):517. doi:10.2519/jospt.2008.0408

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.

La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce

Stress fractures of the femoral neck are rare traumatic events but they are far from being exceptional within the high level sportsmen community and even less rare within the military. The authors report the case of a 19 years old young man enlisted in the French Foreign Legion. He came up with a right femoral neck stress fracture as a result of intense physical exercices. Although painful prodromic signs had been evolving for 15 days, the right diagnosis wasn’t made until the fracture moved to Garden III. The surgical treatment consisted in a reduction with a triple screwing of the femoral neck. One year later, the fracture was set to anatomic position, the hip function was normal and the femoral head showed no signs of osteonecrosis. The patient was then lost for further follow-up. When there has been no slipping, these fractures develop favourably with an ad integrum hip restoration. On the other hand, a secondary slipping leads to a pathology that has to be taken care of in a quite different way, with an often catastrophic outcome at the functional level. Nearly constant prodromic signs come in usefully for an early diagnosis. Secondary slipping of the femoral neck stress fractures should happen less frequently by an appropriate awareness campaign aimed at all the health professionals including sports trainers.