Femoral Neck Stress Fractures in Sport: A Current Concepts Review

Abstract

Femoral neck stress fractures (FNSFs) account for 3% of all sport-related stress fractures. The commonest causative sports are marathon and long-distance running.The main types of FNSF are compression-sided, tension-sided and displaced. The most common reported symptom is exercise-related groin pain. Radiographs form the first line of investigation, with MRI the second-line investigation.The management of FNSFs is guided by the location and displacement of the fracture. Delay in diagnosis is common and increases the likelihood of fracture displacement. Sporting outcomes are considerably worse for displaced fractures. Education programmes and treatment protocols can reduce the rates of displaced FNSFs.This article aims to provide a current concepts review on the topic of FNSFs in sport, assess the current evidence on the epidemiology and pathophysiology of these injuries, detail the current recommendations for their imaging and management, and review the recorded sporting outcomes for FNSFs in the existing literature.From this study, we conclude that although FNSFs are a rare injury, they should be considered in all athletes presenting with exercise-related hip pain, because delay in diagnosis and subsequent fracture displacement can significantly impair future return to sport. However, when detected early, FNSFs show promising results in terms of return-to-sport rates and times.

Stressfraktur i lårhalsen

“…Det er vanligvis lite komplikasjoner ved en inkomplett (ikke-gjennomgående frakturlinje) og ikke-dislokert stressfraktur som kan behandles konservativt, med unntak av refraktur (18). Hvis skaden ikke oppdages, og dermed forblir ubehandlet, kan det oppstå en forskyvning av lårhalsfrakturen som fører til tilhelingsproblemer (pseudartrose, nonunion) og avaskulaer nekrose i femurhodet.…”

“…Tidlig artrose kan også oppstå. Dislokerte stressfrakturer som må behandles kirurgisk, kan utvikle de samme komplikasjonene, i tillegg til postoperativ infeksjon (4,9,18). Forskjellige studier viser at 18 til 25 % av de som behandles kirurgisk, får avaskulaer nekrose i femurhodet postoperativt, avhengig av grad av feilstilling og operativ behandlingsmetode (6).…”

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.…”

“…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…”