Sports involving running, jumping and dancing place the individual at a higher risk of a bone stress injury. Typically they are seen in runners or other athletes who perform repetitive impact to the lower extremities. Pdf spontaneous stress fractures of the femoral neck. Stress fractures of the femoral neck and coxa vara. Pdf stress fractures of the femoral neck and coxa vara. All patients were involved in increased repetitive activity without evidence of violent trauma.
Being over the age of 50 or having a medical condition that. We report a case of femoral neck stress fracture in an 11yearold girl. Jul 17, 2017 the mri of her pelvis was performed 6 days later figure 3c, identifying a left femoral neck stress fracture on the medial side without cortical bone involvement and with surrounding edema of the spongy bone. Once the displaced fracture occurs, serious associated complications can develop, including avascular necrosis, pseudoarthrosis, malunion, and nonunion. Femoral neck stress fractures fnsfs in healthy young subjects are uncommon and most prevalent among longdistance runners and military recruits. Location of a stress fracture and associated potential for delayed union, nonunion, and refracture facilitate designation of a fracture as either high risk or low risk. Femoral neck stress fracture in a 21 years female medcrave.
The aetiology includes repeated force above a certain load without internal bone. A femoral neck fracture occurs one to two inches from the hip joint. Stress fracture of the femoral neck in a child stress. Jan 01, 2011 when stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. These fractures are common among older adults and can be related to osteoporosis. A variation on the typical stress fracture of the hip is the kind of fracture seen in the upper femur which can. Although rare, they have the potential to be one of the most serious injuries in sport, because left untreated, with subsequent fracture propagation and displace ment, they can result in avascular necrosis avn of the femoral. Femoral neck stress fractures are classified according to the origin, severity and progression of the fracture. When present, a fracture line is seen as a linear area of hypointense signal, extending at right angles from the affected cortex, and visible on all sequences of the mr scan 10,53, 56. Running with hip pain femoral neck stress fractures april, 2017 by erin parish. Stress fractures commonly occur in sports where the movement demands of the sport produce repetitive loads on the body. Stress fracture of the femoral neck as a complication of revision arthroplasty of the knee. Femoral neck fracture surgery, pathophysiology and. This topic is focused on overuse stress injury of the femur in physically active individuals, and will discuss patterns of femoral stress fractures both epidemiologic and pathoanatomic.
Immediate treatment of a femoral neck fractureor any hip fracture, for that matteris essential to mitigating a host of possible complications. Fullerton and snowdy 102 modified devas original classification system 105 and described three types of fracture patterns. Case report bilateral stress fractures of the femoral neck. This type of fracture usually requires surgical fixation.
The width of marrow edema for lowgrade fnsis and the measurement of macroscopic fracture as a percentage of femoral neck width for highgrade fnsis were assessed in largefov coronal stir images and measured perpendicular to the long axis of the femoral neck in the coronal image that best. In one large series they accounted for 5% of all stress fractures. Gymphysical therapy program progression from one step to the next is based solely on pain symptoms. Femoral neck fatigue fractures are most common in athletes and young military recruits.
Femoral neck stress fractures are considered highrisk for complications, particularly displacement. Bilateral stress fractures of the femoral neck after total. Nov 23, 2019 hip fractures are often thought of an older persons injury, but active younger people are also at risk because of falls, auto accidents, and overuse stress fractures. This months article will outline the return to sport plan for our patients after femoral neck stress fractures fnsf. Management and treatment of femoral neck stress fractures. Thirteen were found to have some variant of femoral neck or intertrochanteric fracture, indicating the utility of bone scintigraphy for occult hip fractures 3 days postinjury. Bilateral stress fractures of the femoral neck occurring simultaneously following a bilateral tka have been seen in only 2 cases till now. A direct fall on the hip, completion of fatigue fracture or twisting of the body over the hip are all possible causes of a fractured neck in the elderly.
Stress fractures classification compression sided callus fracture at inferior aspect femoral neck tension sided callus fracture at superior aspect femoral neck displaced. May 31, 2017 radiographs are often initially negative for stress fractures, including femoral neck stress fractures. Femoral neck stress fracture differential diagnoses. Femoral neck stress fracture in a young female recruit. Although quite rare it is caused by prolonged overuse. Nondisplaced compression type stress fractures can be treated. Pdf stress fractures of the femoral neck in runners. Deep thigh or groin pain, particularly while doing activity, is the most common and noticeable symptom of femoral stress fracture. A femoral neck stress fracture is a worrisome cause of hip and groin pain in athletes. Femoral neck stress fractures in children and adolescents. Femoral neck stress fracture in elderly population mathews open.
Although rare, they have the potential to be one of the. It is not until the healing phase, approximately 3 weeks after onset, that the stress fractures may become apparent on standard radiographs. Femoral neck fracture physiotherapy management in detail femoral neck fracture physiotherapy management after surgery. Sep 17, 2019 stress fractures are most common in the weightbearing bones of the lower leg and foot. The typical femoral neck fracture patient is frail and elderly. 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. You should never feel pain unless it is that of muscle sorenessstiffness. Femoral neck stress fractures fnsfs comprise around 3 % of all stress fractures seen in the athlete 29. Differential diagnosis of a femoral neckhead stress fracture. They are more common in the femoral neck, the tibial shaft, the metatarsals, and other bones of the foot. Case report bilateral stress fractures of the femoral neck in. Femoral neck stress fractures are unusual but not rare athletic injuries.
Tensiontype femoral neck stress fractures involve the superiorlateral aspect of the neck and are at highest risk for complete fracture. Early recognition of the signs and symptoms of this injury is important, as objective findings are often delayed. Five new cases of femoral neck stress fracture children and adolescents are added to seven cases in the literature. Following fuellerton and snowdy, the injury was classified as a type ii, compressionside, incomplete, fnsf with a good prognosis. 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. The highest incidence of femoral stress fracture occurs at the femoral neck where the top of the thighbone joins the hip and pelvis.
Trauma is the most common cause of femoral neck fractures. With worsening severity of the stress injury, these signals are found to span an increasing width of the femoral neck 10, 53, 56. Compression injuries generally occur at the inferomedial cortical bone of the femoral neck have better outcomes due to the reduced risk of displacement. These are usually managed conservatively with good outcomes.
There are 2 types of femoral neck stress fractures. A followup examination by the orthopedic surgeon revealed a femoral stress fracture to the proximal onethird medial side of the right femur. The mri of her pelvis was performed 6 days later figure 3c, identifying a left femoral neck stress fracture on the medial side without cortical bone involvement and with surrounding edema of the spongy bone. 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. Mri can detect the early changes of bone stress injury and can be very helpful in differentiation of fatigue frac ture from transient osteoporo sis, softtissue injury, tumor and infection 1. However, increased morbidity from displacement of the fracture, delayed. A stress fracture of the femoral neck traversing almost completely across the width of the bone. Stress fractures do not often occur in the shaft of the femur. Stress fracture of the femoral neck robert howells. Femoral neck fractures can be traumatic or stress fractures. Pain may come on gradually as a dull ache, which intensifies if a bending force is applied to the femur. Stress fracture of the femoral neck as a complication of total arthroplasty of the knee. Track and field athletes and military recruits who carry heavy packs over long distances are at highest risk, but anyone can sustain a stress fracture.
Being over the age of 50 or having a medical condition that weakens your bones, such as osteoporosis, increases your risk of a fracture in the femoral neck. Stress fractures of the femoral neck can be difficult to diagnose, since standard radiographs are typically not diagnostic in the early stages. Stress fractures of the femoral neck represent an incisive incident for runners, and early consideration in the differential diagnosis of hip pain is required to avoid potential longterm sequelae. We studied 22 stress fractures of the femoral neck, 12 in patients with coxa vara group a and 10 in patients with a normal neck shaft angle group b, to assess the possible influence of the. In this months question for physiotherapists dr john best will deliver part 2 of his article on femoral neck stress fractures fnsf. Femoral neck stress fracture fnsf is a rare cause of anterior hip pain and the diagnosis becomes difficult.
The most common symptom of a femoral neck fracture is pain in the groin that gets worse when you put weight on the hip or try to rotate the hip. The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. This application of excessive load to the bone will result in an imbalance between bone formation and bone resorption. Stress fractures of the femoral neck represent an incisive incident for runners, and early consideration in the differential diagnosis of hip pain is. One week later, his condition worsened and he reported signs and symptoms similar to those experienced initially. A rare case of bilateral stress fractures of the femoral neck. As such, it is best to consider the stress fracture of the femoral neck a distinct entity, as we do. The concurrent bilateral stress fractures of the femoral neck sffn are extremely rare injuries in individu als without excessive bone activities. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the femur which forms the hip joint. Unilateral stress fracture of the femoral neck following total knee arthroplasty tka is a rare complication.
Due to concern for a femoral neck stress fracture, the patient was instructed in a nonweightbearing gait with axillary crutches. Most fractures healed uneventfully with appropriate treatment. Femoral neck stress fractures are hip injuries which occur just below the femoral head, or the ballandsocket hip joint. Stress fracture of the femoral neck is rare and often initially missed. By contrast, the typical patient with a stress fracture of the femoral neck which at times progresses to a full fracture is a young and vigorous athlete. These require early diagnosis and treat ment to avoid catastrophic consequences. The wound is inspected for evidence of infection and the. Running with hip pain femoral neck stress fractures the. Femoral neck stress fractures account for less than 5% of all stress fractures. A femur stress fracture is a hairline fracture of the femur thigh bone. Diagnosis, treatment, and rehabilitation of stress fractures.
Femoral neck stress fracture in a male runner journal of. Apr, 2017 femoral neck stress fractures can be classified as compression or tension type. Stress fractures account for between 1% and 20% of. Patients present with unremitting hip pain without a history of. Running with hip pain femoral neck stress fractures. Nov 25, 2012 femoral neck stress fractures are unusual but not rare athletic injuries. Stress fractures of the femoral shaft in womens college. A femoral neck stress fracture fnsf is a nasty injury, often requiring months until. This area of the thigh bone, or femur, is known as the femoral neck. The treatment of femoral neck stress fractures is based on fracture pattern.
A stress fracture is a partial or a complete fracture that is a result of the repetitive application of stress to the bone. One of the earliest classification systems is the garden classification of subcapital femoral neck fractures, which classifies femoral neck fractures into four types based on the displacement of the femoral. If plain radiographs do not reveal stress fracture of the femoral. It is unlikely that this exercise was the primary cause of her stress fracture, but it is possible. The potential problems from this fracture are serious. Biomechanics of femoral neck fractures in runners lower. Stress fractures of the femoral neck are uncommon injuries.
Case report femoral neck stress fracture in a young female recruit. One can lead to the other, particularly with overuse combined with poor nutrition. Femoral neck stress fracture journal of orthopaedic. Repeating xray films in 2 weeks may show the changes of a stress fracture, but approximately 20% of cases do not. Answer thank you for your question concerning the development of a femoral neck stress fracture.
The physical therapist also ordered radiographs of the pelvis and bilateral hips, which were initially interpreted as normal figure 1. Displaced stress fracture of the femoral neck in an active. Femoral neck stress fracture is extremely rare in childhood. The physical therapist also ordered radiographs of the pelvis and bilateral hips, which were initially interpreted as normal. Pdf stress fracture of the femoral neck as a complication. Femoral neck stress fractures happen when the ball is disconnected from the rest of the femur.
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