Although stress fractures of the femoral neck have been previously reported in both the pediatric' and elderly8, 10, 17 patient population, these stress fractures have been described most often in young military recruits,1,3,ll,16,18,27 and in recent years in runners. 2,14,19,28 In most cases, stress fractures of the femoral neck are nondisplaced, respond well to treatment with rest, and are associated with minimal morbidity.1,18,19,27 In contrast, displaced stress fractures of the femoral neck are associated with a high incidence of nonunion, avascular necrosis, and degenerative arthritiS.1,1,8, &dquo; Bargren et al.3 developed a preventive program that demonstrates the effectiveness of increased clinical suspicion and early diagnosis in increasing the number of stress fractures diagnosed and decreasing the number displaced.Many studies have been published on bone grafting as a supplement to operative treatment of displaced femoral neck fractures secondary to trauma.5,9,13,15,20-23 Few reports, however, have addressed the use of bone grafting specifically in the treatment of displaced stress fractures of the femoral neck.8,16,29,31 This case report demonstrates the successful use of a Meyers muscle pedicle bone graft in this situation.
CASE REPORTA 32-year-old male was seen by his family physician in September 1983, with a chief complaint of left anterior proximal thigh pain. The patient had been an avid runner the preceding 12 to 18 months. He had worked gradually to the point of running 8 to 10 miles per day at the time of evaluation. He was diagnosed with a left quadriceps muscle strain and treated with rest and analgesics. No radiographs were obtained. The patient resumed running, but for shorter distances because of persistent pain.Approximately 2 months after the initial visit, the patient stepped off of a curb and experienced severe pain in the same region of his left thigh. At this time, he received a similar diagnosis with the pain being attributed to aggravation of the previously diagnosed strained quadriceps muscle group. Radiographs were not obtained. After a period of rest, the patient resumed jogging, but began to develop a limp and significant pain while jogging.In July 1984, the patient was referred to an orthopaedic specialist because of progressive pain in his left hip. The patient showed Trendelenburg's symptom, and significant atrophy of the left quadriceps muscle. He had 1.5 to 2 cm of shortening of the left lower extremity and a painful limited range of motion. A positive Trendelenburg sign was noted on the left. Radiographs (Fig. 1) revealed nonunion of a displaced left femoral neck fracture. The patient had no history of problems or surgery in this area. He had no history of previous fractures and all laboratory studies were normal.The patient was hospitalized and initially treated with skeletal traction through a proximal tibial pin. This treatment reduced the coxa vara deformity. The patient then underwent open reduction and internal fixation of his left femoral neck fracture with a ...