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Femoral Neck Stress Fracture: Difference between revisions
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Femoral neck stress fractures are a rare sport-related stress fracture, most commonly seen in long distance runners. | Femoral neck stress fractures are a rare sport-related stress fracture, most commonly seen in long distance runners. | ||
== Epidemiology == | ==Epidemiology== | ||
Most commonly seen in long distance runners. This is due to repetitive submaximal loading in combination with relative energy deficiency.<ref name=":0">{{Open access icon}}{{Cite journal|last=Robertson|first=Greg A.|last2=Wood|first2=Alexander M.|date=2017-02|title=Femoral Neck Stress Fractures in Sport: A Current Concepts Review|url=https://pubmed.ncbi.nlm.nih.gov/30539087|journal=Sports Medicine International Open|volume=1|issue=2|pages=E58āE68|doi=10.1055/s-0043-103946|issn=2367-1890|pmc=6226070|pmid=30539087}}</ref> They account for 3% of all sport-related stress fractures. | Most commonly seen in long distance runners. This is due to repetitive submaximal loading in combination with relative energy deficiency.<ref name=":0">{{Special|2}}{{Open access icon}}{{Cite journal|last=Robertson|first=Greg A.|last2=Wood|first2=Alexander M.|date=2017-02|title=Femoral Neck Stress Fractures in Sport: A Current Concepts Review|url=https://pubmed.ncbi.nlm.nih.gov/30539087|journal=Sports Medicine International Open|volume=1|issue=2|pages=E58āE68|doi=10.1055/s-0043-103946|issn=2367-1890|pmc=6226070|pmid=30539087}}</ref> They account for 3% of all sport-related stress fractures. | ||
== Clinical Features == | ==Clinical Features == | ||
Patients report a gradual onset poorly localised hip or groin pain that is exacerbated with weight-bearing exercise. The most consistent examination finding is pain at extreme end range of motion, particularly internal rotation.<ref name=":0" /> | Patients report a gradual onset poorly localised hip or groin pain that is exacerbated with weight-bearing exercise. The most consistent examination finding is pain at extreme end range of motion, particularly internal rotation.<ref name=":0" /> | ||
== Classification == | ==Classification == | ||
*Compression sided: infero-medial femoral neck | |||
*Tension sided: supero-lateral femoral neck | |||
*Displaced | |||
*Atypical tension | |||
==Differential Diagnosis== | |||
Ā | |||
== Differential Diagnosis == | |||
{{DDX Box|ddx-text=*Femoral Neck Stress Fractures | {{DDX Box|ddx-text=*Femoral Neck Stress Fractures | ||
*Femoral Head Avascular Necrosis | *Femoral Head Avascular Necrosis | ||
| Line 23: | Line 24: | ||
*[[Adductor Tendinopathy]]}} | *[[Adductor Tendinopathy]]}} | ||
== Investigations == | ==Investigations == | ||
Plain films are usually taken first. But quite often MRI is needed for definitive diagnosis. | Plain films are usually taken first. But quite often MRI is needed for definitive diagnosis. | ||
| Line 42: | Line 43: | ||
|- | |- | ||
|grade 4 | |grade 4 | ||
|changes on STIR, T1, and T2 with a fracture line present | | changes on STIR, T1, and T2 with a fracture line present | ||
|} | |} | ||
== Treatment == | == Treatment== | ||
Compression sided fractures are usually treated conservatively with activity modification. Tension sided fractures may need surgery to reduce the risk of fracture completion and [[osteonecrosis]]. | Compression sided fractures are usually treated conservatively with activity modification. Tension sided fractures may need surgery to reduce the risk of fracture completion and [[osteonecrosis]]. | ||
== References == | ==References== | ||
{{Special interest}} | |||
[[Category:Fractures]] | [[Category:Fractures]] | ||
[[Category:Pelvis, Hip and Thigh Conditions]] | [[Category:Pelvis, Hip and Thigh Conditions]] | ||
<references /> | |||
Revision as of 16:20, 5 June 2022
This article is still missing information.
Femoral neck stress fractures are a rare sport-related stress fracture, most commonly seen in long distance runners.
Epidemiology
Most commonly seen in long distance runners. This is due to repetitive submaximal loading in combination with relative energy deficiency.[1] They account for 3% of all sport-related stress fractures.
Clinical Features
Patients report a gradual onset poorly localised hip or groin pain that is exacerbated with weight-bearing exercise. The most consistent examination finding is pain at extreme end range of motion, particularly internal rotation.[1]
Classification
- Compression sided: infero-medial femoral neck
- Tension sided: supero-lateral femoral neck
- Displaced
- Atypical tension
Differential Diagnosis
Differential Diagnosis
- Femoral Neck Stress Fractures
- Femoral Head Avascular Necrosis
- Hip Labral Tear
- Femoroacetabular Impingement
- Hip Osteoarthritis
- Iliopsoas Tendinopathy
- Rectus Femoris Tendinopathy
- Adductor Tendinopathy
Investigations
Plain films are usually taken first. But quite often MRI is needed for definitive diagnosis.
MRI features include: periosteal oedema and fractur line.
| Grade | Features |
|---|---|
| grade 1 | signals changes only on STIR |
| grade 2 | changes on STIR and T2 |
| grade 3 | changes on STIR, T1, and T2 with no fracture line present |
| grade 4 | changes on STIR, T1, and T2 with a fracture line present |
Treatment
Compression sided fractures are usually treated conservatively with activity modification. Tension sided fractures may need surgery to reduce the risk of fracture completion and osteonecrosis.
References
Papers of particular interest have been highlighted as: ā of special interest āā of outstanding interest
- ā 1.0 1.1 āā
Robertson, Greg A.; Wood, Alexander M. (2017-02). "Femoral Neck Stress Fractures in Sport: A Current Concepts Review". Sports Medicine International Open. 1 (2): E58āE68. doi:10.1055/s-0043-103946. ISSN 2367-1890. PMC 6226070. PMID 30539087. Check date values in: |date=(help) - ā Arendt, E. A.; Griffiths, H. J. (1997-04). "The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes". Clinics in Sports Medicine. 16 (2): 291ā306. doi:10.1016/s0278-5919(05)70023-5. ISSN 0278-5919. PMID 9238311. Check date values in:
|date=(help)
