The patient was referred to an orthopaedic surgeon and subsequently. Once the underlying disease was controlled, the fracture was treated by valgus osteotomy with good result. Stress fractures of the femoral neck everything you need. Pdf femoral neck stress fractures in south korean male. The femoral neck is an uncommon location for stress fractures. Hip and groin pain in patients atrisk for femoral neck stress fracture demand a careful workup including advanced imaging in the setting of normal radiographs. Nov, 2018 atraumatic fractures including stress fractures, atypical femoral fractures, and pathologic fractures are encountered frequently in the emergency department. This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad. Right coronal t1weighted magnetic resonance image of the right hip demonstrating mild convexity of the lateral aspect of the femoral neck arrow indicating a mild camtype deformity which can be seen in femoroacetabular impingement. Ebraheims educational animated video describes stress fractures of the femoral neck.
Stress fracture of the femoral neck in a marine trainee. Femoral neck stress fracture in a 21 years female medcrave. The concurrent bilateral stress fractures of the femoral neck sffn are extremely rare injuries in individuals without excessive bone activities. Stressrelated injuries around the lesser trochanter in long. The basicervical fractures present a number of similarities with the trochanteric. However, if the patient has groin and anterior thigh pain, it. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. Stress fractures of the fem oral neck sffn are relatively uncommon, and. All cases in which radiography was used as the single imaging modality to diagnose an fnsi had a complete macroscopic fracture spanning the entire width of the femoral neck obviating further evaluation with mri. Jul 17, 2015 femoral neck fractures are often described as subcapital, transcervical, or basicervical in location, and as either displaced or nondisplaced. Case history a 23yearold indian girl presented with a history of periodic. This could bring potential serious consequences if an early diagnosis an d treatment is not accomplished. He was diagnosed with a stress fracture of the femoral neck and treated surgically using a dynamic hip screw dhs. Stress fractures of the femoral neck start as an incomplete fracture, which may initially be difficult to see on standard xrays figure 6a and b.
We studied 22 stress fractures of the femoral neck, 12 in patients with coxa vara group a and 10 in. The first report that has been found of a stress fracture in the femoral neck was made. The femoral neck stress fracture in this patient may have arisen as the result of a different mechanism than that seen in postmenopausal osteoporosis, since an xray of the right femoral neck showed no bone atrophy and the bmd of the cancellous bone was also in the normal range. Stress fracture of the femoral neck is rare and often initially missed. It is unlikely that this exercise was the primary cause of her stress fracture, but it is possible. Originally identified in military recruits, 1 stress fractures are now recognised as overuse injuries of the athlete. Delbets anatomic classification delbet classifies neck fractures into.
Bilateral stress fractures of the femoral neck from renal. An mri shows focal, intense marrow edema in the superiorlateral femoral neck. Femoral neck stress fractures in south korean male. Femoral neck stress fracture differential diagnoses. Four of these fractures were of the transverse and three of the compression type. For example, a stress injury to the femoral neck with a cortical fracture necessitates abstention from weightbearing and close monitoring for progression. Management of femoral neck stress fracture in an athlete using. This report describes one case of bilateral stress fracture of the femoral neck in an elderly patient and its surgical management. Sep, 2020 if you repeatedly put too much pressure or weight on the bone, it can break at the hip the femoral neck and cause a stress fracture.
Stress fractures in the femoral neck are not often seen on plain film because 67% may involve only cancellous bone, rather than cortical bone. Differential diagnosis of a femoral neckhead stress fracture. However, due to the limited sensitivity of radiographs, magnetic resonance imaging of the right hip was obtained,1 which revealed a stress fracture of the right distal femoral neck figure 2. Various such fractures have ing to the involved knee should alert the clinician to however been reported. Femoral neck stress fractures are rare in children. Fonte h, rodriguespinto r 2018 femoral neck stress fracture in a young female recruit. Permissions and reprints abstract femoral neck stress fractures fnsfs account for 3% of all sportrelated stress fractures. Femoral neck stress injury with negative bone scan american. Concurrent bilateral femoral neck stress fractures in a military. Fiftyfour fractures in 49 patients were identified in a 4 year prospective study that included 1,049 stress fractures of all types. Femoral neck stress fracture fnsf is a rare cause of anterior hip pain and the diagnosis becomes difficult. Stress fractures are common in todays active and athletic population. Repetitive vigorous activity, abnormal quality of bone or morphologic abnormalities involving proximal femur such as. Femoral neck stress fractures in young adults are uncommon and usually not considered in the differential diagnosis of low back pain.
That is more likely to happen to an elderly person. Stress fractures of femoral neck are rare injuries and are usually seen in military recruits, marathon runners, and elderly with osteoporosis, renal rickets, steroid abuse, and metabolic bone diseases. Theoretically, coxa vara substantially modifies the biomechanical conditions of the femoral neck, increasing the effect of direct muscle pull and leading to fatigue of opposing muscle groups. Apr 01, 2005 in addition to the femoral neck stress fractures, pubic stress fractures and subtrochanteric stress fractures have also been described. Mri can help guide management by defining the exact anatomic location and facilitating grading of the degree of stress injury. In the present report, a case of a healthy, 38yearold male recreational marathon runner who presented in the emergency department is discussed. Sep 29, 2018 femoral neck fractures in young populations are usually caused by highenergy trauma. Pdf on oct 1, 2015, joshua david harris and others published femoral neck stress fractures find, read and cite all the research you need.
Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. A femoral stress fracture is different from a broken hip after a fall. A high index of clinical suspicion is required in athletes presenting with a history of insidious onset, exertional groin pain and pain at the extremes of hip motion on examination. Femoral neck stress injury with negative bone scan.
The most common reported symptom is exerciserelated groin pain. In one large series they accounted for 5% of all stress fractures. Femoral neck stress fractures fnsfs comprise around 3 % of all stress fractures seen in the athlete 29. The bone scan demonstrated a discretely localized area of increased radionuclide uptake in the femoral neck, which alerted us to the correct diagnosis. Pdf stress fractures of the femoral neck in runners. Differential diagnosis of a femoral neckhead stress. Although rare, they have the potential to be one of the. The incidence of stress fractures varies with the population studied, but it is common in runners, with estimates ranging from 9% to 31% of track and field athletes. Femoral neck stress fractures fnsfs are rare, representing 5% of all stress fractures, and they are most prevalent among runners and military recruits. Nondisplaced tensionsided fractures and displaced fractures warrant operative fixation, while nondisplaced compressionside fractures can be. Femoral neck stress fracture of a male, healthy marathon.
Femoral stress fractures occur from overuse, like from long distance running or doing. May 31, 2017 radiographs are often initially negative for stress fractures, including femoral neck stress fractures. Stress fractures classification compression sided callus fracture at inferior aspect femoral neck tension sided callus fracture at superior aspect femoral neck displaced. Subcapital femoral neck tension stress fracture a rare. Stress fractures of the femoral neck are most commonly seen in athl. A femoral neck stress fracture fnsf is a nasty injury, often requiring months until. Stress fractures of the femoral neck represent an incisive incident for runners, and early consideration in the differential diagnosis of hip pain is. Stress fractures are common injuries caused by repetitive microtraumas of the bone.
The potential problems from this fracture are serious. While most stress fractures are found in the tibia, they can rarely occur in the femoral neck. Successful treatment of a complete femoral neck stress fracture. Pdf stress fractures of the femoral neck frederick kummer. Adults, femoral neck, stress fracture, diagnosis, treatment introduction stress fracture is a kind of overuse injury, which is primarily caused by repetitive and excessive mechanical load on bones, rather than a single traumatic event 1. The commonest causative sports are marathon and longdistance running. In seven such fractures, three occurred in young adults, and four in elderly adults. Pdf stress fracture of the femoral neck as a complication.
The femoral neck is the most common location for a hip fracture. We present a case with compression type stress fracture in the right femoral neck, and displaced type stress fracture in the left femoral neck which might progress from an undiagnosed tension type fracture. Bone scanning or magnetic resonance imaging may be necessary to rule out a stress fracture. Early recognition of the signs and symptoms of this injury is important, as objective findings are often delayed. Nov 25, 2012 femoral neck stress fractures are unusual but not rare athletic injuries. The main types of fnsf are compressionsided, tensionsided and dis placed.
Femoral neck stress fracture preted as normal figure 1. Femoral neck stress fractures fnsfs account for 3 % of all sportrelat ed stress fractures. Femoral neck fractures misseddelayed diagnosis pain from hip fractures may obscure associated injuries. Case report bilateral stress fractures of the femoral neck. Answer thank you for your question concerning the development of a femoral neck stress fracture.
Bilateral involvement of femoral neck in a healthy, nonathletic young adult is an extremely rare entity. Stress fracture of the femoral neck in a marine trainee female. We report one such case of a 36yearold male who presented with bilateral groin pain. Diagnosis, treatment, and rehabilitation of stress. The cause of stress fracture of femoral neck is thought to be multifactorial. Pdf stress fractures of the femoral neck and coxa vara. To the best of our knowledge, the tension type stress fracture has been reported only twice in the english language literature. Stress fractures of the femoral neck in athletes, the conse quenceofadelayindiagnosis. Stress fracture of the femoral neck after the pipkin type.
Bilateral subtrochanteric stress riser fractures following. Only the first two types are considered to be real femoral neck fractures. Individual study of the mechanism of the fracture is justified because the cause of ipsilateral subcapital stress fractures after tka might be different in each case. Fiftyfour femoral neck stress fractures were studied prospectively to evaluate treatment methods. Femoral stress fracture symptoms, treatment, and prevention. Spontaneous bilateral femoral neck fractures associated with a low serum level of vitamin d in a young adult. Air force basic trainees and to present new data on risks factors for developing fnsf. Devas, hastings, england from the stress fracture bureau, institute of clinical research, the middlesex hospital, london the first report that has been found of a stress fracture in the femoral neck was made by asal in 1936. The diagnosis of a stress fracture was initially missed because the patients were not exceedingly active and the plain roentgenograms were essentially normal. The characteristic symptom was exertional hip pain. Case report open access a displaced stress fracture of the. Femoral neck stress fracture in a young female recruit. Stress fractures rarely involve the intertrochanteric region.
An atraumatic or minimally traumatic fracture is defined as a fracture caused by a relatively lowenergy mechanism that normally would not be expected to cause a fracture. Pdf stress fractures of the femoral neck frederick. Case report bilateral stress fractures of the femoral neck in. The purpose of this study was to describe and investigate fnsf in u. Jan 01, 2014 femoral neck stress fractures fnsfs account for 2% of all stress fractures but result in disproportionate burden in terms of cost and convalescence. Femoral neck stress fracture in elderly population mathews open. Rehabilitation and return to running after lower limb. Stress fracture of the femoral neck as a complication of. A physician must first rule out those causes which are potentially dangerous. We present a case with compression type stress fracture in the right femoral neck, and displaced type stress fracture in the left femoral neck which. Femoral stress fractures typically present with hip, groin, gluteal, thigh, or knee pain, depending on the location. Fracture in the femoral neck usually can be classified into one of two types. Cureus stress fracture of bilateral neck of femur in a. In a normal femur under normal walking or running conditions, the compressive stress generally predominates in the femoral neck area.
Case report bilateral stress fractures of the femoral neck in adults. Pdf femoral neck stress fracture presenting as low back pain. Stress fractures of the femoral neck are uncommon, accounting for 5% of all stress fractures, being one of the most severe and disabling complications in training military personnel. Stress fractures of the femoral neck everything you need to. Nowadays, they are widespread amongst the athletes. Management and treatment of femoral neck stress fractures in recreational runners. Concomitant injuries, especially head injuries can lead to delay in diagnosis up to 20% of hip fractures often missed in newborns and infants stress fractures may be ignored as hipgroin sprains. A femoral neck stress fracture fnsf is a nasty injury, often requiring months until the patient may return to preinjury training levels. Stress fracture of the femoral neck sffn as a consequence. However, a person whose femoral neck is longer andor more horizontal is at a. A delay in diagnosis can lead to fracture displacement, which negatively impacts outcomes. We report on a five years followup of a 10yearold boy with this injury which was initially missed.
These distinctions are important because the blood supply to the femoral head is at risk following fractures within the hip joint. Stress fractures of the femoral shaft in womens college. Once diagnosed you must consider telling your patient that this may be the worst sports injury you will ever have. Totheauthors knowledge, this is the first case report that untreated. The aetiology includes repeated force above a certain load without internal bone. A rare case of spontaneous bilateral stress fractures of femoral neck leading to coxa vara in a young female with history of chronic renal disease and secondary osteomalacia is described. Pdf bilateral stress fractures of the femoral neck in. Air force recruit presented with hip pain during his second week of basic training and was diagnosed with bilateral femoral neck stress fractures. Imaging features and management of stress, atypical, and. Dec 11, 2018 femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. Femoral neck stress fracture in air force basic trainees. Surgical treatment was performed in 3348 cases and was significantly higher p 0. Simultaneous bilateral femoral neck stress fracture in a. Repeating xray films in 2 weeks may show the changes of a stress fracture, but approximately 20% of cases do not.
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