Femoral Neck Stress Fractures: Outcome Analysis at Minimum Five-year Follow-up

Weistroffer, Joseph K.; Muldoon, Michael; Duncan, Douglas; Fletcher, Eugene H.; Padgett, Douglas E.

doi:10.1097/00005131-200305000-00003

Cited by 26 publications

(13 citation statements)

References 14 publications

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“…Symptoms often develop after initiating or increasing the intensity of a conditioning program [6]. Although nondisplaced FNSFs almost uniformly heal with appropriate treatment, there have outcomes do not always correlate with radiographic union [19,26]. Some patients have long-term hip pain and decreased functional scores despite radiographic resolution [26].…”

Section: Discussionmentioning

confidence: 99%

“…Although nondisplaced FNSFs almost uniformly heal with appropriate treatment, there have outcomes do not always correlate with radiographic union [19,26]. Some patients have long-term hip pain and decreased functional scores despite radiographic resolution [26]. Unrecognized or untreated, this injury will progress, resulting in fracture displacement.…”

Section: Discussionmentioning

confidence: 99%

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Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Kuhn¹,

Riccio

Saldua

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Kuhn¹,

Riccio

Saldua

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…If the fracture is detected quickly and no dislocation has occurred, the recovery rate is usually good, but displaced femoral neck stress fractures can result in devastating complications or even permanent handicap [5,7]. …”

Section: Introductionmentioning

confidence: 99%

Genetic predisposition for femoral neck stress fractures in military conscripts

et al. 2010

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BackgroundStress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures.ResultsEight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI.ConclusionsOur findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

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“…8,14,38 It is estimated that up to 5% of all stress fractures involve the femoral neck, with another 5% involving the femoral head. 14,58,64 Classical clinical presentation of stress fractures of the proximal femur includes deep aching pain in the hip or groin region radiating into the knee, usually worse with activity and better with rest, and night pain is not uncommon. 20 Authors have noted a delay in diagnosis of femoral neck stress fractures leading to a high complication rate.…”

mentioning

confidence: 99%

“…Once the displaced fracture occurs, serious associated complications can develop, including avascular necrosis, pseudoarthrosis, malunion, and nonunion. 3,14,64 Stress fractures are generally classified as fatigue or insufficiency fractures. Fatigue stress fractures are caused by repeated abnormally high forces from muscle action and/or weight-bearing torques, and are often found in persons with normal bone densities.…”

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confidence: 99%

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

Gurney

Boissonnault²,

Andrews³

2006

J Orthop Sports Phys Ther

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Study Design: Resident's case problem. Background: Identifying stress fractures of the hip can be a challenging differential diagnosis. Pain presentation is not always predictable and radiographs may not show the fracture, especially during its early stages. Hip stress fractures left untreated can displace and necessitate open reduction internal fixation or total hip arthroplasty. Diagnosis: A 70-year-old woman presented to the physical therapy clinic with complaints of right hip pain. She had been evaluated by a physician and radiographs of the hip, which revealed some arthritic changes, were otherwise normal. Upon examination, the physical therapist observed an antalgic gait, a noncapsular pattern of limitation of hip motion, an empty painful end feel at the end range of motion (ROM) for hip abduction, external rotation, and flexion, and extreme tenderness to palpation over the anterior hip region. The therapist suspected a more pernicious problem than osteoarthritis and discussed his suspicion with the physician. The physician subsequently requested an MRI that revealed a femoral neck and head stress fracture that was later confirmed with a bone scan. The patient was provided with a walker for ambulation with a non-weight-bearing status for 6 weeks, after which she returned to physical therapy for progressive weight bearing and strengthening. She was discharged with a relatively pain-free hip and was ambulating with a cane. A 2-month follow-up examination revealed a pain-free hip and a return to all premorbid activities, including ambulation without an assistive device. Discussion: The presence of a normal radiograph of the hip should not be considered conclusive in ruling out a stress fracture in the hip region. The current case demonstrates how careful evaluation can reveal occult pathologies and prevent potentially catastrophic morbidity. J Orthop Sports Phys Ther 2006;36:80-88.

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Femoral Neck Stress Fractures: Outcome Analysis at Minimum Five-year Follow-up

Abstract: Femoral neck stress fractures can result in devastating problems for young adults. Appropriately treated patients, regardless of treatment method, may have persistent complaints.

Cited by 26 publications

References 14 publications

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures

Genetic predisposition for femoral neck stress fractures in military conscripts

Differential Diagnosis of a Femoral Neck/Head Stress Fracture

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