Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Abstract

Acetabular retroversion (AR) alters load distribution across the hip and is more prevalent in pathologic conditions involving the hip. We hypothesized the abnormal orientation and mechanical changes may predispose certain individuals to stress injuries of the femoral neck. We retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 54 patients (108 hips) treated for a femoral neck stress fracture (FNSF) and compared these radiographs with those for a control group of patients with normal pelvic radiographs. We determined presence of a crossover sign (COS), femoral neck abnormalities, and neck shaft angle. The prevalence of a positive COS was greater in patients with stress fractures than in the control subjects (31 of 54 [57%] versus 17 of 54 [31%], respectively) and higher than for control subjects reported in the literature. Thirteen patients had radiographic changes of the femoral neck consistent with femoroacetabular impingement (FAI). These radiographic abnormalities were seen more commonly in retroverted hips. A greater incidence of AR was noted in patients with FNSF. Potential implications include more aggressive screening of military recruits with AR and the new onset of hip pain. Finally, we present an algorithm we use to diagnose and treat these relatively rare FNSFs.

Acetabular fracture types vary with different acetabular version

“…While the architecture of the proximal femur and pelvis was found to have an influence on the risk and type of hip fractures [24,25], the role of the acetabular orientation and geometry in fracture pathogenesis of the acetabulum itself remains unclear.…”

Stress Fracture of the Femoral Neck in Patient With Excessive Acetabular Anteversion and Coxa Profunda: A Case Report

“…It is considered as a main pathophysiology to understand osteoarthritis of hip. However, a study about high prevalence of radiologic finding of acetabular retroversion, a form of femoroacetabular impingement in patients with stress fracture in military recruits had reported [4]. We propose a possible relationship between the stress fracture of femoral neck and femoroacetabular impingement in case report of patient who had the stress fracture with hip of excessive acetabular anteversion and coxa profunda.…”

“…Biomechanically, direct muscle pulling effect increases in coxa vara and leads to fatigue of opposing muscle group. Recently, the paper about femoral neck stress fracture which is related with FAI was published [4].…”

“…The acetabular rim acts as a fulcrum on which the femoral neck fracture is strained repetitively with motion across the fracture. And higher incidence of acetabular retroversion, a form of pincer type impingement, is found in military recruits with femoral neck stress fractures than the normal people [4]. But nevertheless the association between acetabular retroversion and femoral neck stress fracture, it is unclear whether the presence of acetabular retroversion is a true risk factor for development of a femoral neck stress fracture.…”

Letter to the Editor: Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

“…To the Editor, I read the article by Kuhn et al [4] with great interest. I have several comments on the association of acetabular retroversion with femoral neck stress fracture.…”