The Hip: Preservation, Replacement and Revision

Stress Fractures of Femoral Neck

- Discussion:
    - stress frx of femoral neck are relatively uncommon injuries, with most reports involving military recruits & athletes who are subjected to increased physical demands;
    - like most stress frx, women are most often affected and it is important to inquire about amenorrhea and occult eating disorders;
           - these patients will also require an osteoporosis work up and quantification of bone density;
    - patients may note groin pain that is made worse with activity and that is relieved with rest;
    - diff dx: AVN and transient osteoporosis;

- Radiographs:
    - initial radiographs are often normal, but even late radiographs may fail to show reactive changes;
    - radiographic evidence of disruption of both cortices or frx widening is indication for prompt internal fixation to prevent displacement;
    - classification of stress frx:
           - stress frxs are classified as either tension or compression frx;
           - compression frxs occur on the inferior aspect of the femoral neck;
                   - look for internal callus at the inferior femoral neck;
           - tension fractures occur on the superior aspect of the femoral neck;
                   - causes a transverse fracture across the femoral neck;
                   - this fracture type is more likely to progress and displace;
- Bone Scan / MRI:
    - bone scan or MRI is necessary to identify the fracture;

- MRI:
    - is an alternative to bone scan and allows an early diagnosis;
    - look for decreased signal intensity on T1 and increased signal on T2; 
    - see NEJM teaching case;

- Nonsurgical Treatment
    - must include frequent serial radiographs to detect any changes in frx pattern or displacement.
    - compression frxs occur on the inferior aspect of the femoral neck;
         - are more stable than tension frxs & generally can be treated w/o surgery if no frx line is present;
    - non operative therapy consists of a period of bed rest followed by protected wt bearing;
    - serial radiographs are manditory;

- Surgical Treatment:
    - fractures of both cortices must undergo immediate internal fixation;
    - tension fractures occur on the superior aspect of the femoral neck;
         - they are potentially unstable & should undergo internal fixation;
    - see technique of cannulated screw insertion;

- Complications:
    - AVN may follow a delay in diagnosis

Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis.

Insufficiency stress fractures of the femoral neck in elderly women.

Femoral neck stress fractures in children and adolescents

Surgical treatment of displaced stress fractures of the femoral neck in military recruits: a report of 42 cases.

Atypical Tensile-Sided Femoral Neck Stress Fractures. The Value of Magnetic Resonance Imaging.

Subchondral Fatigue Fracture of the Femoral Head in Military Recruits.

Displaced Femoral Neck Fatigue Fractures in Military Recruits.

Long-term outcome of undisplaced fatigue fractures of the femoral neck in young male adults.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 13, 2012 4:25 pm