Laterale Schenkelhalsstressfraktur eines 29-jährigen Marathonläufers – eine seltene und risikobehaftete Überlastungsfraktur des Sportlers

Abstract

ZusammenfassungEin 29-jähriger Leistungssportler beklagte während der Wettkampfvorbereitung seit einer Woche einen dumpfen Hüftschmerz. Während des Wettkampfmarathons musste der Sportler schlussendlich nach 29 Kilometern aufgrund anhaltender Schmerzen den Wettkampf abbrechen. In der anschließenden unmittelbar durchgeführten Diagnostik zeigte sich eine mäßig verschobene laterale Schenkelhalsfraktur. Die Fraktur wurde notfallmäßig operativ mittels dynamischer Hüftschraube versorgt. Wenige Tage später konnte der Patient bei reizlosen Wundverhältnissen die Klinik verlassen. Nach Abschluss der Behandlung konnte er ohne Beeinträchtigungen zum regelmäßigen Training zurückkehren. Zu weiteren Komplikationen kam es nicht. Bei Schmerzen im Bereich der Leiste bzw. lateralen Hüftregion während lang anhaltender läuferischer Belastung muss als Differenzialdiagnose, auch im jungen Alter, eine äußerst seltene Stressfraktur des Schenkelhalses in Betracht gezogen werden. Eine verspätete Diagnostik und Therapie können das Ergebnis nicht nur deutlich verschlechtern, sondern auch das Hüftgelenk insgesamt gefährden.

Treatment and Rehabilitation Approaches for Stress Fractures in Long-Distance Runners: A Literature Review

“…The mean age of the patients was 33.2 ± 13.1 years with a range between 15 and 64 years. Fourteen male [ 25 - 27 , 30 , 33 , 34 , 36 , 37 , 39 , 40 , 42 - 44 , 46 ] and 10 female [ 23 , 24 , 28 , 29 , 31 , 32 , 35 , 38 , 41 , 45 ] long-distance runners were diagnosed with a femur SF. Among the 24 identified femur SFs, 20 of them were observed in the femoral neck [ 23 - 27 , 29 - 43 ], three of them in the femoral shaft [ 28 , 44 , 45 ], and only one fracture involved the condyle [ 46 ].…”

“…Three patella SF cases involving two male and one female long-distance runner are presented in recent literature [ 67 , 69 , 70 ]. The mean age of the three injured athletes was 39.7 ± 17.3 years [ 25 , 30 ] and 64 years old, respectively. It is notable that two of them had bilateral patella SFs [ 67 , 69 ], while the third one had a longitudinal SF [ 70 ].…”

“…Of the 73 cases examined in this study, 35 patients were male [ 3 , 19 - 21 , 25 - 27 , 30 , 33 , 34 , 36 , 37 , 39 , 40 , 42 - 44 , 46 , 47 , 50 , 53 , 54 , 56 , 58 , 59 , 62 , 67 , 70 ] while 38 were female [ 23 , 24 , 28 , 29 , 31 , 32 , 35 , 38 , 41 , 45 , 48 , 49 , 51 , 52 , 55 , 57 - 61 , 63 - 66 , 69 ], showing a small propensity for SFs in female population. However, the literature shows a higher tendency of SFs in females compared to male long-distance runners [ 6 , 7 ].…”

“…Fourteen male [25][26][27]30,33,34,36,37,39,40,[42][43][44]46] and 10 female [23,24,28,29,31,32,35,38,41,45] long-distance runners were diagnosed with a femur SF. Among the 24 identified femur SFs, 20 of them were observed in the femoral neck [23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], three of them in the femoral shaft [28,44,45], and only one fracture involved the condyle [46]. The treatment strategy has been described in 18 out of 20 reported femoral neck SF cases in the literature [23]…”

“…Among the 24 identified femur SFs, 20 of them were observed in the femoral neck [23][24][25][26][27][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], three of them in the femoral shaft [28,44,45], and only one fracture involved the condyle [46]. The treatment strategy has been described in 18 out of 20 reported femoral neck SF cases in the literature [23][24][25][26][27][29][30][31][32][33][34][35][36][38][39][40]42,43]. To our knowledge, seven out of 18 cases were treated conservatively [23,24,31,32,34,35,39], whereas the remaining 11 cases w...…”