Femoral Neck Stress Fracture

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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

Investigations

Plain films are usually taken first. But quite often MRI is needed for definitive diagnosis.

MRI features include: periosteal oedema and fractur line.

Classification system by Arendt and Griffiths.[2]
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: ◆ of special interest ◆◆ of outstanding interest

  1. 1.0 1.1 ◆◆ open accessRobertson, Greg A.; Wood, Alexander M. (2017-02). "Femoral Neck Stress Fractures in Sport: A Current Concepts Review". Sports Medicine International Open. 1 (2): E58–E68. doi:10.1055/s-0043-103946. ISSN 2367-1890. PMC 6226070. PMID 30539087. Check date values in: |date= (help)
  2. 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): 291–306. doi:10.1016/s0278-5919(05)70023-5. ISSN 0278-5919. PMID 9238311. Check date values in: |date= (help)