Summary
Femoral neck stress fractures are unusual but not rare athletic injuries. In one large series they accounted for 5% of all stress fractures. Early recognition of the signs and symptoms of this injury is important, as objective findings are often delayed. The potential problems from this fracture are serious. The aetiology includes repeated force above a certain load without internal bone response time. Loss of shock absorption due to muscle fatigue and limitation of ankle motion by boots or splints may also play a role. The diagnosis is based on the finding of groin pain and radiographic testing, which often requires plain films and bone scintigraphy. Regular radiographic findings present in stages progressing from a normal film through sclerosis to a disruption of the cortex and displacement. Bone scintigraphy may be positive 2 or more weeks before plain film changes are present. Classification schemes follow the radiographic changes. A classification system and treatment plan may be based on 3 categories of these fractures — compression side, tension side and displaced femoral neck fracture. Treatment ranges from rest with early symptoms to surgical stabilisation for any widening of cortical cracks and/or displaced fractures. Prompt diagnosis and carefully supervised treatment is the key to preventing displacement. Prolonged disability secondary to pain, nonunion or avascular necrosis is associated with displacement of the femoral neck stress fracture.
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References
Belding RH. Stress fractures of the femoral neck. Orthopaedic Transactions 4(3): 377, 1980
Black J. Failure of implants for internal hip fixation. Orthopaedic Clinics of North America 5(4): 833–845, 1974
Blickenstaff LD, Morris JM. Fatigue fracture of the femoral neck. Journal of Bone and Joint Surgery 48A: 1031–1047, 1966
Devas MB. Stress fractures of the femoral neck. Journal of Bone and Joint Surgery 47B: 728–738, 1965
Devas MB. Stress fractures, p. 113, Churchill Livingston, Edinburgh, 1975
Ernst J. Stress fracture of the neck of the femur. Journal of Trauma 4: 71–73, 1964
Fullerton LR, Snowdy HA. Femoral neck stress fractures. American Journal of Sports Medicine 16(4): 365–377, 1988
Greaney RB, Gerber FA, Laughlin RL, et al. Distribution and natural history of stress fractures in U.S. Marine recruits. Radiology 146: 339–346, 1983
Kaltsas DS. Stress fractures of the femoral neck in young adults. Journal of Bone and Joint Surgery 63B: 33–37, 1981
Lombardo SJ, Benson D. Stress fractures of the femur in runners. American Journal of Sports Medicine 10: 219–227, 1982
Meurman KOA, Elfring S. Stress fractures in soldiers: a multi-focal bone disorder. Radiology 134: 483–487, 1980
Milgrom C, Chisin R, Giladi M, et al. Negative bone scans in impending tibial stress fractures: a report of three cases. American Journal of Sports Medicine 12: 488–491, 1984
Morris JM, Blickenstaff LD. Fatigue fractures: a clinical study, Charles C. Thomas, Springfield, IL, 1967
Prather JL, Nusynowitz ML, Snowdy HA, et al. Scintigraphic findings in stress fractures. Journal of Bone and Joint Surgery 59A: 869–874, 1977
Scully TJ, Besterman JB. Stress fracture — a preventable training injury. Monograph from Orthopaedic and Rehabilitation Department, William Beaumont Army Medical Center, El Paso, 1979
Wilcox JR, Monrit AL, Green JP. Bone scanning in the evaluation of exercise-related stress injuries. Radiology 123: 699–703, 1979
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Fullerton, L.R. Femoral Neck Stress Fractures. Sports Med 9, 192–197 (1990). https://doi.org/10.2165/00007256-199009030-00006
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DOI: https://doi.org/10.2165/00007256-199009030-00006