Bilateral femoral neck stress fractures in military recruits with unilateral hip pain

Abstract

Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits.

Total Hip Arthroplasty for Bilateral Femoral Neck Stress Fracture: A Case Report and Review of the Literature

“…Miller has reported the first documented case of bilateral FNSF in the literature in 1950 [4]. Cases of bilateral femoral neck fractures, even simultaneous, have been reported in healthy military recruits [5][6][7][8][9] as well as in healthy nonathletes [10,11]. Insufficiency or fatigue bilateral fractures of the femoral neck have been described in various conditions such as pregnancy [12]; bone metabolic diseases, caused by osteomalacia associated with coxa vara [13] or by celiac disease [14]; vitamin D deficiency [15]; and rare genetic syndromes like Marfan [16] and autosomal dominant osteopetrosis [17].…”

Bilateral femoral neck stress fractures in a high-performance young female runner

“…A stress fracture may be most accurately defined as a complication derived from abnormal bone homeostasis due to the repetitive mechanical impact, which in turn leads to an increased osteoclastic-mediated bone resorption 1–8…”

“…Mostly uncommon, stress fractures amount to 10% of all sports-related injuries, femoral neck stress fractures being 3%–5% of the whole 2–7. It is mainly observed among military recruits and young female athletes due to constant exposure of the bone to repetitive loading in a specific area, which in turn predisposes for microfracture accumulation 1–4 9.…”

“…The main risk factors that are worth mentioning are as follows:Female gender (especially those presenting the athlete triad that consists in the coexistence of amenorrhea, eating disorders and premature osteoporosis) 1–4 6Being a high-performance athlete 1–6 9Prior stress fracture history.Fracture predisposing comorbidity (such as hormonal, autoimmune, neoplastic and nutritional disorders) 4 6…”

“…During the early stages, femoral neck stress fractures can present themselves only when the subject is actively exercising and it is characterised by the onset of deep pain in the hip or anterior groin regions, an inability to carry weight, presenting antalgic gait and a limited motion range 1–7…”