Femoral Neck Stress Fracture

Aka: Femoral Neck Stress Fracture

1. See Also
   1. Groin Injuries in Athletes
   2. Stress Fracture
2. Pathophysiology
   1. As with other Stress Fractures, overuse injury more common in female athletes
3. Risk Factors
   1. See Stress Fracture
   2. Similar risks to Pubic Ramus Stress Fracture (military recruits, distance runners)
4. Symptoms
   1. Groin Pain or anterior thigh pain
   2. Provoked by activity (weight bearing)
   3. Relieved with rest
5. Signs
   1. Antalgic Gait
   2. Pain on internal hip rotation
6. Imaging
   1. Hip XRay
      1. XRay changes lag symptoms by 2-4 weeks
   2. MRI preferred over nuclear bone scan
      1. High Test Sensitivity (similar to bone scan)
      2. High Test Specificity (better than bone scan)
7. Management
   1. Early diagnosis and management is critical to avoid a devastating complete Hip Fracture
   2. Risk Modification
      1. See Stress Fracture
      2. Image the opposite hip if Stress Fracture is found (bilateral Hip Stress Fractures are common)
   3. Inferior Femoral Neck Stress Fractures (medial, compressive or compression side)
      1. Period of non-weight bearing and Crutches
      2. Conservative management (as long as involves <50% of cortex)
      3. Return to Running and sport in 8-12 weeks
   4. Superior Femoral Neck Stress Fractures (lateral, tensile or tension side)
      1. Risk of complete Fracture or Hip Avascular Necrosis
      2. Open reduction and internal fixation recommended
8. References
   1. Shahideh (2013) Crit Dec Emerg Med 27(9):10-18
   2. Morelli (2001) Am Fam Physician 64(8):1405-1414 [PubMed]